Wang M, Zhang LL, Wang G, Miao YC, Zhang T, Qiu L, Fang GD, Lu F, Xu DL, Yu P. Comparative study of clinical efficacy of laparoscopic proximal gastrectomy with double-channel anastomosis and tubular gastroesophageal anastomosis. World J Gastrointest Surg 2025; 17(1): 101204 [DOI: 10.4240/wjgs.v17.i1.101204]
Corresponding Author of This Article
Yong-Chang Miao, Department of Gastrointestinal Surgery, The Second People’s Hospital of Lianyungang, No. 41 Hailian East Road, Lianyungang 222000, Jiangsu Province, China. lygeymyc@163.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which 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: http://creativecommons.org/licenses/by-nc/4.0/
Mian Wang, Department of Nail and Breast Surgery, The Second People’s Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
Li-Li Zhang, Department of Emergency Medicine, Lianyungang Second People’s Hospital, Lianyungang 222000, Jiangsu Province, China
Gang Wang, Yong-Chang Miao, Tao Zhang, Lei Qiu, Gui-Da Fang, Feng Lu, Da-Lai Xu, Peng Yu, Department of Gastrointestinal Surgery, The Second People’s Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
Co-corresponding authors: Gang Wang and Yong-Chang Miao.
Author contributions: Zhang LL, Qiu L, Wang M, and Zhang T conceived, designed, and refined the study protocol; Zhang LL, Wang M, and Xu DL acquired and analyzed the data; Qiu T and Zhang T wrote the manuscript; Fang GD, Yu P, and Lu F contributed to the data analyses; Wang G provided clinical advice; Wang G and Miao YC supervised the report and provided the funding acquisition; and all authors have read and approved the final version. Zhang LL and Wang M contributed equally to this work as co-first authors; Wang G and Miao YC contributed equally to this work as co-corresponding authors. There are two reasons for this designation. First, the research was performed as a collaborative effort, and the designation of co-corresponding authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. This also ensures effective communication and management of post-submission matters, ultimately enhancing the paper’s quality and reliability. Second, Zhang LL and Wang M contributed efforts of equal substance throughout the research process. The choice of these researchers as co-first authors acknowledges and respects this equal contribution while recognizing the spirit of teamwork and collaboration in this study. In summary, we believe that designating Zhang LL and Wang M as co-first authors/Wang G and Miao YC as co-corresponding authors is appropriate for our manuscript, as it accurately reflects our team’s collaborative spirit, equal contributions, and diversity.
Supported by the “521 Project” Funding Project Day of Lianyungang.
Institutional review board statement: This study was reviewed and approved by the Second People’s Hospital of Lianyungang (approval No. 2024k035).
Informed consent statement: Data was de-identified and retrospectively collected, and therefore informed consent was not required from each patient.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: Dataset available from the corresponding author at lygeymyc@163com.
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 NonCommercial (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: Yong-Chang Miao, Department of Gastrointestinal Surgery, The Second People’s Hospital of Lianyungang, No. 41 Hailian East Road, Lianyungang 222000, Jiangsu Province, China. lygeymyc@163.com
Received: September 9, 2024 Revised: October 6, 2024 Accepted: November 1, 2024 Published online: January 27, 2025 Processing time: 109 Days and 0 Hours
Abstract
BACKGROUND
According to statistics, the incidence of proximal gastric cancer has gradually increased in recent years, posing a serious threat to human health. Tubular gastroesophageal anastomosis and double-channel anastomosis are two relatively mature anti-reflux procedures. A comparison of these two surgical procedures, tubular gastroesophageal anastomosis and double-channel anastomosis, has rarely been reported. Therefore, this study aimed to investigate the effects of these two reconstruction methods on the quality of life of patients with proximal gastric cancer after proximal gastrectomy.
AIM
To compare short-term clinical results of laparoscopic proximal gastrectomy with double-channel anastomosis vs tubular gastric anastomosis.
METHODS
Patients who underwent proximal gastrectomy at our hospital between January 2020 and January 2023 were enrolled in this retrospective cohort study. The patients were divided into an experimental group (double-channel anastomosis, 33 cases) and a control group (tubular gastric anastomosis, 30 cases). Baseline characteristics, surgical data, postoperative morbidities, and postoperative nutrition were recorded.
RESULTS
The differences in baseline data, surgical data, and postoperative complications (20.0% vs 21.2%) were not statistically significant between the two groups. There were no statistically significant differences in the levels of postoperative nutrition indicators between the two groups of patients during the preoperative period and at 3 months postoperatively. In addition, the levels of postoperative nutrition indicators in patients in the experimental group declined significantly less at 6 months and 12 months postoperatively compared with those of the control group (P < 0.05). At 12 months postoperatively, the difference in anastomotic reflux esophagitis between the two groups was statistically significant (P < 0.05) with the experimental group showing less reflux esophagitis.
CONCLUSION
Both double-channel anastomosis and tubular gastric anastomosis after proximal gastrectomy are safe and feasible. Double-channel anastomosis has a better anti-reflux effect and is more beneficial in improving the postoperative nutritional status.
Core Tip: Commonly used reconstruction methods for proximal gastrectomy in clinical practice include tubular gastroesophageal anastomosis, double-channel anastomosis, and other digestive tract reconstruction methods. However, there are few studies on the clinical efficacy comparison between proximal gastrectomy with double-channel anastomosis and tubular gastroesophageal anastomosis for early proximal gastric cancer in China. In this study, both tubular gastroesophageal anastomosis and double-channel anastomosis have reliable surgical safety. Compared with tubular gastroesophageal anastomosis, dual-channel anastomosis has a better anti-reflux effect and is more conducive to improving patients’ postoperative nutritional status.
Citation: Wang M, Zhang LL, Wang G, Miao YC, Zhang T, Qiu L, Fang GD, Lu F, Xu DL, Yu P. Comparative study of clinical efficacy of laparoscopic proximal gastrectomy with double-channel anastomosis and tubular gastroesophageal anastomosis. World J Gastrointest Surg 2025; 17(1): 101204
Gastric cancer is a common malignant tumor of the digestive tract with a poor prognosis. In recent years, with the development of diagnostic and therapeutic techniques, the detection rate of gastric cancer has been increasing every year, but the mortality rate of gastric cancer still ranks fourth among common tumors[1,2]. According to statistics, the incidence of proximal gastric cancer has gradually increased in recent years[3], posing a serious threat to human health[4-6]. Proximal gastrectomy can maintain normal digestive function and maximally promote the digestion and absorption of food. This surgical approach has the advantages of relatively simple anastomosis, reduced gastric resection, and relatively low risk of injury. However, anastomosis of the esophageal stump after traditional proximal gastrectomy is often associated with complications such as reflux esophagitis, anastomotic stenosis, poor nutritional status, low immunity, and increased risk of tumor recurrence or metastasis, which has severely restricted the wide application of proximal gastrectomy. Therefore, clinicians are exploring new anastomotic modalities to reduce the occurrence of postoperative complications after proximal gastrectomy. According to current guideline recommendations, commonly used gastrointestinal reconstruction methods for proximal gastrectomy include gastroesophageal anastomosis, jejunoileal interposition, jejunoileal pouch interposition, and double-channel anastomosis[7]. Among these reconstructive methods, tubular gastroesophageal anastomosis and double-channel anastomosis are two relatively mature anti-reflux procedures. In comparison to the traditional gastroesophageal anastomosis, tubular gastric anastomosis removes part of the gastric antrum, reduces the amount of gastric acid secretion, and increases the route of gastric acid reflux, therefore significantly improving patients’ long-term postoperative quality of life; however, it has been reported that the incidence rate of reflux symptoms is as high as 14.0%-35.0%[8]. Double-channel anastomosis effectively reduces the entry of gastric acid into the esophagus, with an incidence of reflux symptoms at 1.1%-10.0%[9]. A comparison of these two surgical procedures, tubular gastroesophageal anastomosis and double-channel anastomosis, has rarely been reported. Therefore, this study aimed to investigate the effects of these two reconstruction methods on the quality of life of patients with proximal gastric cancer after proximal gastrectomy, and to provide a reference for the choice of digestive tract reconstruction modality in proximal gastric cancer.
MATERIALS AND METHODS
General information
The clinical data of 63 patients who underwent proximal gastric surgery in the Second People’s Hospital of Lianyungang City from January 2020 to January 2023 were retrospectively analyzed, including 33 cases who underwent laparoscopic proximal gastrectomy and double-channel anastomosis (experimental group) and 30 cases who underwent laparoscopic proximal gastrectomy and tubular gastroesophageal anastomosis (control group). There were 23 males and 10 females in the experimental group, with a mean age of 70.79 years ± 9.66 years and body mass index (BMI) of 22.43 kg/m2 ± 2.40 kg/m2. There were 21 males and 9 females in the control group, with a mean age of 69.13 years ± 9.41 years and BMI of 22.98 kg/m2 ± 3.70 kg/m2. The differences in age, gender, BMI, tumor diameter, and TNM stage between the two groups were not statistically significant (Table 1).
Table 1 Comparison of baseline clinicopathological data between the two groups of patients.
Item
LPG-DCA (n = 33)
LPG-TGA (n = 30)
t/χ2/Z value
P value
Sex (n)
Male
23
21
0.001
0.980
Female
10
9
Age (years)
mean ± SD
70.79 ± 9.66
69.13 ± 9.41
0.690
0.500
BMI (kg/m2)
mean ± SD
22.43 ± 2.40
22.98 ± 3.70
-0.700
0.480
TNM stage (n)
I
16
14
-0.306
0.760
II
11
9
III
6
7
Tumor size (cm)
mean ± SD
3.74 ± 0.51
3.60 ± 0.70
0.067
0.361
Tumour differentiation (n)
High
8
6
-0.570
0.569
Medium
15
13
Low
10
11
ASA grade (n)
I
9
10
-0.455
0.649
II
18
15
III
6
5
Inclusion criteria
The inclusion criteria were: (1) Patients with proximal gastric cancer diagnosed by preoperative gastroscopy, enhanced computed tomography (CT), and postoperative pathology; (2) patients who underwent laparoscopic proximal gastrectomy with double-channel anastomosis or tubular gastric anastomosis; and (3) patients with complete clinical data.
Exclusion criteria
The exclusion criteria included: (1) Patients who underwent anastomosis via an approach other than double-channel anastomosis or tubular gastric anastomosis; and (2) postoperative pathological confirmation of failed R0 resection.
Surgical methods
All patients underwent laparoscopic proximal gastrectomy for gastric cancer by an experienced gastrointestinal surgeon. The patients were placed in the supine position, general anesthesia was induced by tracheal intubation, routine skin disinfection was carried out, trocar distribution was conducted using a five-port approach, and the CO2 pneumoperitoneum pressure was maintained at 13 mmHg (1 mmHg = 0.133 kPa). All operations were performed in accordance with the Japanese Guidelines for the Treatment of Gastric Cancer[10].
Double-channel anastomosis
After routine examination of lymph nodes of the tube-shaped stomach and esophagus, the opening of the tube-shaped stomach and esophagus was sutured.
Observed indicators
Basic information: Age, gender, BMI, TNM stage, tumor size, degree of tumor differentiation, and American Society of Anesthesiologists classification were compared between the two groups.
Surgery-related and perioperative indices: The two groups were compared in terms of surgical dissection, transection of the esophagus, and resection of the tumor and the proximal stomach. The jejunum and mesenteric blood vessels were cut at a distance of 20-25 cm from the suspensory ligament of the duodenum. The esophagus was anastomosed with the distal jejunum, and the transected end of the jejunum was closed with a linear stapler, with the blind end being 2-3 cm long. A proximal and distal jejunal anastomosis was performed at 45-50 cm distal to the esophagojejunal anastomosis, side-to-side anastomosis was performed between the jejunum and the anterior wall of the residual stomach at 10-15 cm from the esophagojejunal anastomosis, and the opening was sutured to close the mesangial hiatus.
Tubular gastric anastomosis
Routine lymph node dissection and transection of the esophagus were performed, followed by resection of the tumor and creation of the tubular stomach. In short, the stomach was severed from the angle of the stomach to the junction of the fundus and the greater curvature via a straight line incision, along the side of the lesser curvature of the stomach to produce a curve parallel to the greater curvature of the stomach. Resection of the cardia, the tumor, and some of the gastric curvature tissue was then carried out. The length of the tubular stomach was approximately 20 cm. At 6-8 cm away from the residual end of the incised anterior wall of tubular stomach, tubular gastro-esophageal anastomosis was performed, and the tubular stomach-esophagus opening was sutured. The length of the tube-shaped stomach was usually about 20 cm. The anterior wall of the remnant stomach was incised 6-8 cm from the remnant of the tube-shaped stomach, a straight-line cutting suture was inserted, and a side-to-side anastomosis was conducted. Intraoperative blood loss, number of lymph nodes removed, time to first anal evacuation, time to first intake of clear liquid food, postoperative hospitalization, gastrointestinal reconstruction and operative costs, and postoperative complications were determined.
Postoperative nutritional indicators
The levels of hemoglobin, serum albumin, and total serum protein were compared between the two groups preoperatively and at 3, 6, and 12 months postoperatively.
Gastroesophageal reflux
At the 12-month postoperative follow-up, gastroesophageal reflux was assessed by gastroscopy, and the severity of reflux esophagitis was evaluated using the Los Angeles classification[11].
Follow-up
Follow-up information was collected postoperatively using outpatient clinics, WeChat, and phone calls to assess the patient’s postoperative reflux esophagitis and nutritional status. The follow-up period continued until January 2024.
Statistical analysis
Data were analyzed using SPSS 26.0 software. Normally distributed measurements are expressed as the mean ± SD, and the t-test was used for intergroup comparisons. Count data are expressed as cases (%), and the χ2 test was used for intergroup comparisons of non-hierarchical count data. The Mann-Whitney U test was used for intergroup comparisons of hierarchical count data. P < 0.05 was considered statistically significant.
RESULTS
Basic information
A total of 63 patients were included in this study, including 33 patients in the experimental group and 30 patients in the control group. The differences in age, gender, BMI, TNM stage, tumor size, degree of tumor differentiation, and the American Society of Anesthesiologists grade between the two groups were not statistically significant (Table 1).
Comparison of surgery-related and perioperative indexes
All 63 patients completed the surgery, with no conversion to open surgery and no fatal cases. There was no statistically significant difference between the two groups in terms of the operation time, intraoperative blood loss, number of lymph nodes dissected, time to first anal evacuation, time to intake of first clear liquid food, postoperative hospital stay, digestive tract reconstruction, and surgical cost (Table 2).
Table 2 Comparison of intraoperative and postoperative conditions between the two groups of patients.
Item
Operation time (min)
Intraoperative blood loss (mL)
Retrieved lymph nodes (n)
Time to first exhaust (d)
Time to intake of first soft diet (d)
Postoperative hospital stay (d)
Digestive tract reconstruction time (minute)
Surgical costs (thousands)
LPG-DCA (n = 33)
248.80 ± 56.48
140.85 ± 44.23
34.74 ± 4.89
3.72 ± 0.49
6.03 ± 2.00
15.32 ± 2.98
39.74 ± 5.87
59.09 ± 11.15
LPG-TGA (n = 30)
239.63 ± 49.57
129.53 ± 35.57
32.41 ± 5.13
3.55 ± 0.36
5.29 ± 1.68
14.07 ± 2.75
37.44 ± 5.04
58.32 ± 9.51
t value
0.682
1.112
1.839
1.598
1.583
1.719
1.657
0.292
P value
0.498
0.271
0.071
0.115
0.119
0.091
0.103
0.771
Postoperative complication rate
There was no statistically significant difference in postoperative complications between the two groups (Table 3).
Table 3 Comparison of postoperative complications between the two groups of patients, n (%).
Item
Postoperative complications
Total
Anastomotic leak
Intra-abdominal bleeding
Pleural effusion
Anastomotic stenosis
Intestinal obstruction
Wound infection
LPG-DCA (n = 33)
3 (9.0)
0 (0.0)
2 (6.0)
1 (3.0)
1 (3.0)
0 (0.0)
7 (21.2)
LPG-TGA (n = 30)
2 (6.7)
0 (0.0)
1 (3.3)
0 (0.0)
2 (6.7)
1 (3.3)
6 (20.0)
χ2 value
0.014
P value
0.905
Nutritional status
The preoperative and postoperative nutritional status of the two groups was analyzed by collecting preoperative and postoperative levels of hemoglobin, serum albumin, and total serum protein in the third, sixth, and twelfth postoperative months (Table 4, Figure 1).
Figure 1 Changes in hemoglobin, serum albumin, and total serum protein levels before and after surgery in the two groups of patients.
A: Hemoglobin; B: Albumin; C: Total protein. LPG: Laparoscopic gastrectomy; DCA: Double-channel anastomosis; TGA: Tubular gastric anastomosis; TB: Total serum protein; HGB: Hemoglobin; ALB: Serum albumin.
Table 4 Comparison of nutritional status of the two groups of patients.
At 1 year postoperatively, patients in the experimental group had significantly less severe reflux esophagitis than those of the control group (P < 0.05) (Table 5).
Table 5 Comparison of endoscopic reflux oesophagitis and Visick grade at 12 months postoperatively.
Reflux oesophagitis
LPG-DCA (n = 33)
LPG-TGA (n = 30)
Z value
P value
A
2
5
2.404
0.016
B
1
3
C
0
2
D
0
0
DISCUSSION
Gastric cancer is now one of the top three malignant tumors in terms of incidence rate in China, seriously threatening the lives of the general public[12,13]. Accordingly, with the increasing incidence of proximal gastric cancer and early gastric cancer detection rates, the application of proximal gastrectomy has shown an increasing trend[5,14-16]. With regard to the choice of digestive tract reconstruction methods for proximal gastrectomy, there is still a lack of accepted ideal methods, and the commonly used reconstruction methods include esophagogastric anterior wall anastomosis, tubular gastroesophageal anastomosis, esophagogastric lateral wall anastomosis, bimuscular flap anastomosis, intercalated jejunostomy method, double-channel anastomosis, and others[17]. The tubular gastroesophageal anastomosis and double-channel anastomosis are the main recommended methods[18,19], and there is very little published literature on the clinical effectiveness of double-channel anastomosis in early-stage gastric cancer following proximal gastrectomy compared with tubular gastroesophageal anastomosis in China.
Reflux is the most common complication after proximal gastrectomy, which seriously affects patients’ postoperative quality of life, and limits the widespread implementation of proximal gastrectomy in clinical practice. To reduce the occurrence of postoperative reflux symptoms, researchers have been exploring and improving reconstruction of the digestive tract after proximal gastrectomy. Tubular gastric anastomosis was first reported by the Japanese scholar Shiraishi et al[20] for application in digestive tract reconstruction after proximal gastrectomy. This approach creates a gastric tube with a linear cutting occluder, and removes most of the antrum section that secretes gastric acid, thereby reducing gastric acid while prolonging the distance of reflux. This procedure involves only one anastomosis, which makes the surgery simple, and has been widely promoted and applied in some centers. Ronellenfitsch et al[21] reported that 30% of patients had reflux symptoms after tubular gastroesophageal anastomosis, but the symptoms were mild. Aihara et al[8] showed that the incidence of reflux symptoms after tubular gastroesophageal anastomosis was 14%. Double-channel anastomosis was first proposed by Aikou et al[22] in 1988 and used for digestive tract reconstruction after proximal gastrectomy, which ensures the function of the residual stomach as much as possible and effectively reduces the risk of reflux. Nomura et al[23] showed that 1 year after proximal gastrectomy with double-channel anastomosis, endoscopic visualization of reflux esophagitis occurred in 6.7% of patients. Ji et al[24] retrospectively analyzed the clinical data of 25 patients undergoing proximal gastrectomy with double-channel anastomosis and 39 patients undergoing proximal gastrectomy with esophagogastric anastomosis patients and found that the incidence of reflux esophagitis at 1 year after double-channel anastomosis was 8%. In this study, the incidence of reflux esophagitis after double-channel anastomosis was 9%, which was significantly better than that of tubular gastroesophageal anastomosis. The results of this study further validate that double-channel anastomosis has definite anti-reflux efficacy.
The stomach is a very important organ in the human body, and plays an important role in the process of nutrient intake and food digestion. The biggest advantage of proximal gastrectomy is that it preserves part of the stomach’s storage, digestive, and secretory functions. Anastomosis destroys the integrity of the gastrointestinal tract, which inevitably leads to problems such as unsatisfactory recovery of nutritional status in the postoperative period. However, the postoperative nutritional status is an important indicator of the benefit of a surgical procedure. Double-channel anastomosis preserves the normal physiological channels of the residual stomach and duodenum, which not only serves the functions of the stomach in storing and secreting endogenous factors, but also facilitates the function of the duodenum in eliciting the secretion of cholecystokinin, pancreatic stimulating hormone, etc. Therefore, compared with total gastrectomy, double-channel anastomosis for proximal gastrectomy can significantly improve the patient’s postoperative nutritional status and reduce the occurrence of anemia[25,26], which is in line with the results of studies conducted by Kim et al[27]. Tubular gastrectomy further reduces the size of the remnant stomach, largely depriving it of its storage function, and there is insufficient clinical evidence to support its ability to improve the nutritional status of patients in the postoperative period. The results of the present study showed that there was no statistically significant difference in the nutritional status between the two groups in the preoperative period and at 3 months postoperatively, but at 6 months and 12 months postoperatively, patients in the double-channel anastomosis group had a significantly lower decrease in the levels of hemoglobin, serum albumin, and total serum protein compared with the tubular gastroesophageal anastomosis group (P < 0.05), indicating the advantages of proximal gastrectomy with double-channel anastomosis in maintaining patients’ postoperative nutritional status. This is due to the digestive tract reconstruction method used in double-channel anastomosis, allowing most food to empty through the residual gastroduodenal channel[28], which can help the absorption of all types of nutrient elements. In this study, there was no statistically significant difference in basic clinical data or surgery-related and perioperative indices between the two groups. The average length of surgery in the two groups was 248.80 min ± 56.48 min for dual-channel anastomosis and 239.63 min ± 49.57 min for tubular gastric anastomosis, and although surgery duration was longer in the double-channel anastomosis group, the difference was not statistically significant. This may be because in the double-channel anastomosis group, the dissected jejunum required management and there were more anastomoses during the operation than in the tubular gastric anastomosis group. In addition, improved operator experience was observed in the double-channel anastomosis group, and we believe that the operation time will be further reduced. The amount of intraoperative bleeding is another important factor in evaluating surgical safety. The clinical indicators of intraoperative bleeding, time to first anal evacuation, and postoperative hospital stay were not statistically significant between the groups. In terms of the incidence of postoperative complications, there was no statistically significant differences between the two anastomotic methods, similar to previous studies[29], and this suggests that both anastomotic methods have relatively reliable surgical safety.
With regard to anastomotic stricture, which is a common complication of gastric surgery, this can be caused by esophageal reflux and failure to follow up on postoperative nutrition[30]. We found that there was no significant difference in the risk of anastomotic stenosis between the two groups, and an increased number of anastomoses did not result in anastomotic stenosis. With regard to incision infections, gastrointestinal surgery can cause abdominal infections in addition to incision infections. Few incision infections were observed in both groups of patients. During the operation, all patients’ incisions were protected by an incision protector, a tool that minimizes deep contact with the corresponding tissue at the incision site, thus effectively avoiding infection. Through postoperative follow-up, we found that the two groups had a comparable risk of developing intestinal obstruction, which could be relieved by conservative treatment. The double-channel anastomosis, although with a cumbersome step, did not increase the incidence of postoperative bowel obstruction in patients. Therefore, the safety of this reconstruction method was further confirmed.
CONCLUSION
In summary, both tubular gastroesophageal anastomosis and double-channel anastomosis have reliable surgical safety. Compared with tubular gastroesophageal anastomosis, double-channel anastomosis has a better anti-reflux effect and is more conducive to improving patients' postoperative nutritional status.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Surgery
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade C
Novelty: Grade C
Creativity or Innovation: Grade C
Scientific Significance: Grade B
P-Reviewer: Salimi M S-Editor: Chen YL L-Editor: Wang TQ P-Editor: Zhang XD
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