Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Anti-reflux effects of a novel esophagogastric asymmetric anastomosis technique after laparoscopic proximal gastrectomy
Li-Qun Pang, Jie Zhang, Fang Shi, Cong Pang, Cheng-Wan Zhang, Ye-Liu Liu, Yao Zhao, Yan Qian, Xiang-Wei Li, Dan Kong, Shang-Nong Wu, Jing-Fang Zhou, Cong-Xue Xie, Song Chen
Li-Qun Pang, Jie Zhang, Ye-Liu Liu, Yao Zhao, Yan Qian, Xiang-Wei Li, Cong-Xue Xie, Department of General Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
Fang Shi, Jiangsu Key Laboratory of Advanced Manufacturing Technology, Huaiyin Institute of Technology, Huaian 223300, Jiangsu Province, China
Cong Pang, Department of Neurosurgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
Cheng-Wan Zhang, Department of Central Laboratory, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
Dan Kong, Department of Imaging, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
Shang-Nong Wu, Jing-Fang Zhou, Department of Gastroenterology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
Song Chen, Institute of Medicinal Biotechnology, Jiangsu College of Nursing, Huaian 223300, Jiangsu Province, China
Author contributions: Pang LQ, Zhang J, Shi F, Pang C and Chen S conceived and designed the study; Pang LQ and Zhang J performed the operation; Zhang CW, Shi F, Pang C, Liu YL, Zhao Y, Qian Y, Li XW, Xie CX, Kong D, Wu SN, Zhou JF and Chen S contributed to the study design, analysis, and interpretation of the data; Pang LQ and Chen S wrote the manuscript; all authors reviewed and approved the manuscript; Pang LQ, Zhang J, Shi F, Pang C and Chen S contributed equally to this work.
Institutional review board statement: All experimental and surgical procedures of the study were approved by the ethics committee of The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University and strictly adhered to the guidelines of the Helsinki Declaration of 1964 and its latest amendments.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Li-Qun Pang, MD, PhD, Chief Physician, Surgeon, Surgical Oncologist, Department of General Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, No. 1 Huanghe West Road, Huaian 223300, Jiangsu Province, China. hayypanglq@njmu.edu.cn
Received: March 5, 2023
Peer-review started: March 5, 2023
First decision: April 13, 2023
Revised: May 2, 2023
Accepted: June 19, 2023
Article in press: June 19, 2023
Published online: August 27, 2023
ARTICLE HIGHLIGHTS
Research background
The direction of future research will be focused on investigating the long-term effectiveness of anti-reflux measures with larger patient populations and randomized controlled studies.
Research motivation
The implementation of esophagogastric asymmetric anastomosis (EGAA) proved to be a secure and viable procedure, yielding outstanding anti-reflux results following proximal gastrectomy.
Research objectives
The objective of this research was to investigate the effectiveness of the EGAA technique in preventing reflux after proximal gastrectomy that represents a new approach to anti-reflux surgery.
Research methods
First, we utilized a thermal stress computer simulation to replicate gastric peristalsis at the EGAA site. This was conducted to gain a deeper understanding of the mechanism and efficacy of the anti-reflux function. Subsequently, we performed digestive tract reconstruction on 13 patients who had undergone laparoscopic proximal gastrectomy using the EGAA technique. We closely monitored the structural and functional changes of the reconstruction through imaging exams and gastroscopy after the surgery. Lastly, we conducted follow-up assessments on the patients to determine the effectiveness of the anti-reflux effects.
Research results
The research findings suggest that the valve-like reconstructed structure at the site of EGAA was effective in preventing gastroesophageal reflux in patients who underwent the procedure. However, further studies are needed to evaluate the long-term efficacy and safety of this technique.
Research conclusions
The limitations of current anti-reflux surgical techniques have led to the development of novel methods to prevent postoperative reflux. The EGAA technique is designed to address the shortcomings of conventional techniques by utilizing computer simulation technology to study the anti-reflux mechanism of asymmetric anastomosis. Solving these problems and improving the effectiveness of anti-reflux techniques will have significant implications for the future of gastrointestinal reconstruction and postoperative patient outcomes.
Research perspectives
Our study highlights the increasing proportion of proximal gastric cancer over the past few decades that has resulted in reflux esophagitis becoming a common postoperative complication after proximal gastrectomy. There is a need for a safer method of performing esophageal-gastric anastomosis to reduce the risk of reflux and other complications for patients undergoing this surgery. Esophageal-residual gastric anastomosis after proximal gastrectomy is an effective way to reconstruct the digestive tract, but the loss of anti-reflux function can lead to several postoperative complications, affecting the quality of life of the patient. The significance of this study lies in finding ways to reduce these complications and improve the outcomes for patients.
