PDF(Pubmed)
Abstract：
BACKGROUND: There is no optimal reconstruction method after proximal gastrectomy. The valvuloplastic esophagogastrostomy can reduce postoperative reflux esophagitis, but it is technically complex with a long operation time. The gastric tube anastomosis is technically simple, but the incidences of reflux esophagitis and anastomotic stricture are higher.
METHODS: We have devised a modified valvuloplastic esophagogastrostomy after laparoscopy-assisted proximal gastrectomy (LAPG), the arch-bridge anastomosis. After reviewing our prospectively maintained gastric cancer database, 43 patients who underwent LAPG from November 2021 to April 2023 were included in this cohort study, with 25 patients received the arch-bridge anastomosis and 18 patients received gastric tube anastomosis. The short-term outcomes were compared between the two groups to evaluate the efficacy of the arch-bridge anastomosis. Reporting was consistent with the STROCSS 2021 guideline.
RESULTS: The median operation time was 180 min in the arch-bridge group, significantly shorter than the gastric tube group (p = 0.003). In the arch-bridge group, none of the 25 patients experienced anastomotic leakage, while one patient (4%) experienced anastomotic stricture requiring endoscopic balloon dilation. The postoperative length of stay was shorter in the arch-bridge group (9 vs. 11, p = 0.034). None of the patients in the arch-bridge group experienced gastroesophageal reflux and used proton pump inhibitor (PPI), while four (22.2%) patients in the gastric tube group used PPI (p = 0.025). The incidence of reflux esophagitis (Los Angeles grade B or more severe) by endoscopy was lower in the arch-bridge group (0% vs. 25.0%).
CONCLUSIONS: The arch-bridge anastomosis is a safe, time-saving, and feasible reconstruction method. It can reduce postoperative reflux and anastomotic stricture incidences in a selected cohort of patients undergoing laparoscopy-assisted proximal gastrectomy.
METHODS: We have devised a modified valvuloplastic esophagogastrostomy after laparoscopy-assisted proximal gastrectomy (LAPG), the arch-bridge anastomosis. After reviewing our prospectively maintained gastric cancer database, 43 patients who underwent LAPG from November 2021 to April 2023 were included in this cohort study, with 25 patients received the arch-bridge anastomosis and 18 patients received gastric tube anastomosis. The short-term outcomes were compared between the two groups to evaluate the efficacy of the arch-bridge anastomosis. Reporting was consistent with the STROCSS 2021 guideline.
RESULTS: The median operation time was 180 min in the arch-bridge group, significantly shorter than the gastric tube group (p = 0.003). In the arch-bridge group, none of the 25 patients experienced anastomotic leakage, while one patient (4%) experienced anastomotic stricture requiring endoscopic balloon dilation. The postoperative length of stay was shorter in the arch-bridge group (9 vs. 11, p = 0.034). None of the patients in the arch-bridge group experienced gastroesophageal reflux and used proton pump inhibitor (PPI), while four (22.2%) patients in the gastric tube group used PPI (p = 0.025). The incidence of reflux esophagitis (Los Angeles grade B or more severe) by endoscopy was lower in the arch-bridge group (0% vs. 25.0%).
CONCLUSIONS: The arch-bridge anastomosis is a safe, time-saving, and feasible reconstruction method. It can reduce postoperative reflux and anastomotic stricture incidences in a selected cohort of patients undergoing laparoscopy-assisted proximal gastrectomy.
摘要：
背景：近端胃切除术后没有最佳的重建方法。瓣膜性食管胃吻合术可减少术后反流性食管炎,但是它在技术上很复杂，运行时间很长。胃管吻合术技术简单,但反流性食管炎和吻合口狭窄的发生率较高。
方法：我们设计了腹腔镜辅助近端胃切除术（LAPG）后改良的瓣膜性食管胃造口术，拱桥吻合术.在回顾了我们前瞻性维护的胃癌数据库后，从2021年11月至2023年4月接受LAPG的43例患者纳入本队列研究，其中25例患者接受了拱桥吻合术，18例患者接受了胃管吻合术。比较两组的近期疗效,评价拱桥吻合术的疗效。报告与STROCSS2021指南一致。
结果：拱桥组的中位手术时间为180分钟，显著短于胃管组(p=0.003)。在拱桥组中，25例患者均未出现吻合口漏,而1例患者（4％）经历了需要内窥镜球囊扩张术的吻合口狭窄。拱桥组术后住院时间较短(9vs.11，p=0.034）。拱桥组的患者均未出现胃食管反流并使用质子泵抑制剂（PPI），而胃管组中有4例（22.2％）患者使用了PPI（p=0.025）。通过内窥镜检查，反流性食管炎（洛杉矶B级或更严重）的发生率在拱桥组中较低（0％vs.25.0%）。
结论：拱桥吻合术是安全的，节省时间,可行的重建方法。它可以减少腹腔镜辅助近端胃切除术患者的术后反流和吻合口狭窄发生率。
方法：我们设计了腹腔镜辅助近端胃切除术（LAPG）后改良的瓣膜性食管胃造口术，拱桥吻合术.在回顾了我们前瞻性维护的胃癌数据库后，从2021年11月至2023年4月接受LAPG的43例患者纳入本队列研究，其中25例患者接受了拱桥吻合术，18例患者接受了胃管吻合术。比较两组的近期疗效,评价拱桥吻合术的疗效。报告与STROCSS2021指南一致。
结果：拱桥组的中位手术时间为180分钟，显著短于胃管组(p=0.003)。在拱桥组中，25例患者均未出现吻合口漏,而1例患者（4％）经历了需要内窥镜球囊扩张术的吻合口狭窄。拱桥组术后住院时间较短(9vs.11，p=0.034）。拱桥组的患者均未出现胃食管反流并使用质子泵抑制剂（PPI），而胃管组中有4例（22.2％）患者使用了PPI（p=0.025）。通过内窥镜检查，反流性食管炎（洛杉矶B级或更严重）的发生率在拱桥组中较低（0％vs.25.0%）。
结论：拱桥吻合术是安全的，节省时间,可行的重建方法。它可以减少腹腔镜辅助近端胃切除术患者的术后反流和吻合口狭窄发生率。
