PDF(Pubmed)
Abstract：
BACKGROUND: There is no standard reconstruction method following proximal gastrectomy, of which gastroesophageal reflux and anastomotic complications are of great concern. Though several techniques have been devised to overcome these postoperative complications, such as double tract reconstruction, double-flap technique and side overlap fundoplication by Yamashita, none of them is considered a perfect solution. Herein, we designed a novel method of esophagogastrostomy after laparoscopic proximal gastrectomy (LPG), named right-sided overlap and single-flap valvuloplasty (ROSF).
METHODS: Between March 2021 and December 2021, 20 consecutive patients underwent LPG-ROSF at Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University. Surgical outcomes and postoperative complications were recorded. All patients were followed-up until December 2022. Endoscopy and assessment of gastrointestinal symptoms were performed 1 year after surgery. Nutrition-related parameters including total body weight, hemoglobin, lymphocyte count, serum total protein, serum albumin and serum prealbumin were evaluated 1 year after surgery and compared with those before surgery.
RESULTS: The mean surgery time and anastomosis time was 285.3 ± 71.3 and 61.3 ± 11.2 min respectively. None of the patients had gastrointestinal early postoperative complications. Symptomatic reflux was observed in one patient (5%) while reflux esophagitis (Los Angeles Grade A) was observed in another patient (5%). Four patients (20%) had mild dysphagia (Visick score = II) but none of them had anastomotic stenosis. There were no significant changes in nutritional status postoperatively.
CONCLUSIONS: ROSF can be safely performed after LPG and has satisfactory outcomes in preventing reflux and stenosis, and maintaining nutritional status. This technique requires further validation.
METHODS: Between March 2021 and December 2021, 20 consecutive patients underwent LPG-ROSF at Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University. Surgical outcomes and postoperative complications were recorded. All patients were followed-up until December 2022. Endoscopy and assessment of gastrointestinal symptoms were performed 1 year after surgery. Nutrition-related parameters including total body weight, hemoglobin, lymphocyte count, serum total protein, serum albumin and serum prealbumin were evaluated 1 year after surgery and compared with those before surgery.
RESULTS: The mean surgery time and anastomosis time was 285.3 ± 71.3 and 61.3 ± 11.2 min respectively. None of the patients had gastrointestinal early postoperative complications. Symptomatic reflux was observed in one patient (5%) while reflux esophagitis (Los Angeles Grade A) was observed in another patient (5%). Four patients (20%) had mild dysphagia (Visick score = II) but none of them had anastomotic stenosis. There were no significant changes in nutritional status postoperatively.
CONCLUSIONS: ROSF can be safely performed after LPG and has satisfactory outcomes in preventing reflux and stenosis, and maintaining nutritional status. This technique requires further validation.
摘要：
背景：近端胃切除术后没有标准的重建方法，其中胃食管反流和吻合口并发症备受关注。尽管已经设计了几种技术来克服这些术后并发症，如双道重建，山下双瓣技术和侧重叠胃底折叠术，他们都不被认为是一个完美的解决方案。在这里，我们设计了一种腹腔镜近端胃切除术（LPG）后食管胃吻合术的新方法，命名为右侧重叠和单瓣瓣膜成形术（ROSF）。
方法：在2021年3月至2021年12月之间，有20名连续患者在胃肠外科接受了LPG-ROSF，苏州大学附属第二医院.记录手术效果及术后并发症。所有患者均随访至2022年12月。手术后1年进行内镜检查和胃肠道症状评估。营养相关参数，包括总体重，血红蛋白,淋巴细胞计数,血清总蛋白，术后1年评估血清白蛋白和血清前白蛋白，并与手术前进行比较。
结果：平均手术时间和吻合时间分别为285.3±71.3和61.3±11.2分钟。所有患者均未出现术后早期胃肠道并发症。在一名患者（5％）中观察到有症状的反流，而在另一名患者（5％）中观察到反流性食管炎（洛杉矶A级）。4例患者（20％）有轻度吞咽困难（Visick评分=II），但均无吻合口狭窄。术后营养状况无明显变化。
结论：ROSF可以安全地在LPG后进行，并且在预防反流和狭窄方面具有令人满意的结果，保持营养状况。该技术需要进一步验证。
方法：在2021年3月至2021年12月之间，有20名连续患者在胃肠外科接受了LPG-ROSF，苏州大学附属第二医院.记录手术效果及术后并发症。所有患者均随访至2022年12月。手术后1年进行内镜检查和胃肠道症状评估。营养相关参数，包括总体重，血红蛋白,淋巴细胞计数,血清总蛋白，术后1年评估血清白蛋白和血清前白蛋白，并与手术前进行比较。
结果：平均手术时间和吻合时间分别为285.3±71.3和61.3±11.2分钟。所有患者均未出现术后早期胃肠道并发症。在一名患者（5％）中观察到有症状的反流，而在另一名患者（5％）中观察到反流性食管炎（洛杉矶A级）。4例患者（20％）有轻度吞咽困难（Visick评分=II），但均无吻合口狭窄。术后营养状况无明显变化。
结论：ROSF可以安全地在LPG后进行，并且在预防反流和狭窄方面具有令人满意的结果，保持营养状况。该技术需要进一步验证。
