Double-Flap Technique as an Antireflux Procedure in Esophagogastrostomy after Proximal Gastrectomy

Kuroda, Shigetoshi; Nishizaki, Masahiko; Kikuchi, Shinichi; Noma, Kazuhiro; Tanabe, Satoshi; Kagawa, Shunsuke; Shirakawa, Yasuhiro; Fujiwara, Toshiyoshi

doi:10.1016/j.jamcollsurg.2016.04.041

Cited by 100 publications

(100 citation statements)

References 18 publications

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“…Since the first report by Uyama et al in 1995, laparoscopic PG has been increasingly performed, with several technical reports and small samplesized case studies already published (38)(39)(40)(41)(42). Conversely, PG is expected to preserve the reservoir function of the remnant distal stomach including the pyloric ring function that prevents duodenogastric reflux and to be associated with a lower rate of dumping syndrome (43)(44)(45)(46). Patients who undergo PG may also suffer from heartburn or gastric fullness resulting in esophageal reflux, which could lead to a poor postoperative QOL (31,47).…”

Section: Pgmentioning

confidence: 99%

“…Several reconstruction methods can be adopted after PG, including esophagogastrostomy (38,39,45,46), jejunal interposition (JI) (43,44), and double-tract reconstruction (40,48). Esophagogastrostomy is the simplest reconstruction method; however, it is associated with a high risk of reflux esophagitis and gastroesophageal anastomotic stenosis (47,49).…”

Section: Reconstruction After Pgmentioning

confidence: 99%

“…However, several issues remain to be resolved including endoscopic esophagitis during the postoperative period. In that regard, a promising reconstruction method after PG was laparoscopically performed recently in Japan; esophagogastrostomy was performed using a hand-sewn procedure, and the esophagogastric junction was reconstructed with the double-flap technique to prevent reflux (Figures 3-6) (45,46). The original procedure that formed the basis for this method was designed for conventional open surgery.…”

Section: Reconstruction After Pgmentioning

confidence: 99%

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Function-preserving surgery for gastric cancer: current status and future perspectives

Nunobe

Hiki

2017

Transl. Gastroenterol. Hepatol.

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The number of early gastric cancer (EGC) cases has been increasing because of improved diagnostic procedures including endoscopy and screening systems. Therefore, function-preserving gastrectomy (FPG) for EGC with the expectation of better quality of life (QOL) after surgery may be increasingly utilized, due to its association with low rate of lymph node metastasis and excellent survival and the possibility of employing less invasive procedures such as laparoscopic gastrectomy in combination. Pylorus-preserving gastrectomy (PPG) with curative intent lymph node dissection is a representative FPG that has been used in EGC, and its superiorities, indications, limitations, and survival benefits have already been reported in several retrospective studies. Laparoscopic proximal gastrectomy (LAPG) has also been employed in EGC of the upper third of the stomach; however, LAPG was found to be associated with major issues in achieving a balance between swallowing and reflux prevention. In patients with EGC in the upper third of the stomach, laparoscopy-assisted subtotal gastrectomy with a preserved, albeit very small, stomach may provide a better QOL and fewer postoperative complications. FPG is recommended as a surgical treatment for EGC if the indication is accurately diagnosed and strictly confirmed; however, these techniques in laparoscopic surgery present technical difficulties to surgeons without a certain degree of skills. Although many retrospective studies revealed the functional benefits or oncological safety with FPG, further prospective studies using large case series are necessary to reveal the value of FPG compared with the conventional procedures.

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Section: Pgmentioning

confidence: 99%

Section: Reconstruction After Pgmentioning

confidence: 99%

Section: Reconstruction After Pgmentioning

confidence: 99%

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Function-preserving surgery for gastric cancer: current status and future perspectives

Nunobe

Hiki

2017

Transl. Gastroenterol. Hepatol.

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“…One is addition of the anti-reflux procedure after the esophagogastrectomy. The double flap technique has become particularly popular in Japan (67), but size of the remnant stomach will have to be relatively large to be eligible for this type of reconstruction. Another option is to interpose a short jejunal segment between the esophagus and the gastric remnant (68).…”

Section: The Issue Of Limited Surgery For Early Gastric Cancermentioning

confidence: 99%

The current state of stomach cancer surgery in the world

Kodera¹

2016

Jpn. J. Clin. Oncol.

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The incidence of gastric cancer and the number of gastric cancer patients that a surgeon treats annually are so vastly different between countries and regions that it is not easy to define which type of gastric cancer surgery should be considered the global standard. Nevertheless, a consensus that D2 dissection is the most appropriate way to treat resectable advanced gastric cancer has arguably been reached after long-term follow-up and flexible interpretation of the Dutch D1 versus D2 trial and evidence from the Japan Clinical Oncology Group 9501 study which denied survival benefit of more extensive lymphadenectomy. After the Japan Clinical Oncology Group 9501 trial, surgeons gradually lost interest in attempting to improve survival through extended resection and instead began to expend greater resources on establishing and standardizing the technique of minimally invasive surgery and proving its oncological non-inferiority compared with the conventional approach. Laparoscopic distal gastrectomy has become an option in daily clinical practice in the Far East, and more demanding procedures such as laparoscopic total gastrectomy and laparoscopic surgery for advanced gastric cancer are currently being explored in clinical trials from the viewpoint of both safety and oncological feasibility. In addition, the high proportion of early-stage cancer in the Far East prompted surgeons to develop limited surgery such as proximal gastrectomy and pyloruspreserving gastrectomy, which warrant further evaluation regarding benefits in terms of postoperative nutritional state and/or quality of life measurements to convince the rest of the world.

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“…LAPG offers oncological safety and nutritional benefits over total gastrectomy. More recently, esophagogastrostomy using the double‐flap technique has been adopted by some institutes, and favorable results have been reported . However, LAPG with this technique is technically demanding when the tumor is located at the esophagogastric junction (EGJ).…”

Section: Introductionmentioning

confidence: 99%

Esophagogastric junction cancer successfully treated by laparoscopic proximal gastrectomy and lower esophagectomy with intrathoracic double‐flap technique: A case report

Hosoda

Yamashita

Moriya

et al. 2017

Asian J Endoscop Surgery

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A 66-year-old man was referred to our hospital for treatment of esophagogastric junction cancer. He was diagnosed as cT2N0M0, and the esophageal invasion was found to be 1 cm from the esophagogastric junction. He underwent laparoscopy-assisted proximal gastrectomy and lower esophagectomy with esophagogastrostomy using the intrathoracic double-flap technique through the transhiatal approach. The operative time was 662 min (suturing time was 198 min), and blood loss was 200 mL. The operative time was much longer for this procedure than for esophagogastrostomy with the conventional (intra-abdominal) double-flap technique. The postoperative course was uneventful. No abnormal gastroesophageal reflux, esophageal motility, or lower esophageal sphincter (LES) pressure was demonstrated 3 months after the operation. Laparoscopic proximal gastrectomy and lower esophagectomy with esophagogastrostomy using the double-flap technique through the transhiatal approach is safe and feasible. It may be recommended for patients with esophagogastric junction cancer with esophageal invasion of about 1 cm.

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Double-Flap Technique as an Antireflux Procedure in Esophagogastrostomy after Proximal Gastrectomy

Cited by 100 publications

References 18 publications

Function-preserving surgery for gastric cancer: current status and future perspectives

Function-preserving surgery for gastric cancer: current status and future perspectives

The current state of stomach cancer surgery in the world

Esophagogastric junction cancer successfully treated by laparoscopic proximal gastrectomy and lower esophagectomy with intrathoracic double‐flap technique: A case report

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