Double tract reconstruction versus double flap technique: short-term clinical outcomes after laparoscopic proximal gastrectomy for early gastric cancer

Yu, Byunghyuk; Park, Ki Bum; Park, Ji Yeon; Lee, Seung Soo; Kwon, Oh Kyoung; Chung, Ho Young; Hwang, Yoon Jin

doi:10.1007/s00464-021-08902-3

Cited by 12 publications

(18 citation statements)

References 28 publications

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“…Moreover, none of the patients in our study developed anastomotic leakage. Similar to the reasons described above, left-sided single ap may also prevent potential leakage as a consequence of ap ischemia and necrosis, though anastomotic leakage is reported very rare in DFT patients [17,18].…”

Section: Advantages In Reducing Anastomotic Complicationsmentioning

confidence: 75%

Laparoscopic Proximal Gastrectomy with Right-Sided Overlap and Single-Flap Valvuloplasty (ROSF): A Case-Series Study

Peng

Yan

Huang

et al. 2023

Preprint

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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. 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.

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Section: Advantages In Reducing Anastomotic Complicationsmentioning

confidence: 75%

Laparoscopic Proximal Gastrectomy with Right-Sided Overlap and Single-Flap Valvuloplasty (ROSF): A Case-Series Study

Peng

Yan

Huang

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Moreover, none of the patients in our study developed anastomotic leakage. Similar to the reasons described above, left-sided single flap may also prevent potential leakage as a consequence of flap ischemia and necrosis, though anastomotic leakage is rare in DFT patients [ 21 , 22 ] (Tables 5 , 6 ). Theoretically, ROSF may reduce the possibility of leakage better than SOFY, since the anastomosis is covered by the flap, though anastomotic leakage was not reported in SOFY [ 15 ].…”

Section: Discussionmentioning

confidence: 93%

Laparoscopic proximal gastrectomy with right-sided overlap and single-flap valvuloplasty (ROSF): a case-series study

et al. 2023

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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.

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“…Consequently, the choice of a reasonable approach to reconstruct the digestive tract after proximal gastrectomy and addressing complications, such as reflux esophagitis, remain a challenge for clinicians ( 10 – 13 ). Therefore, an increasing number of clinical studies have focused on improving reconstruction modalities after proximal gastrectomy, such as esophagogastrotomy (EG), jejunostomy (JI), jejunal pouch placement (JPI) and double tract reconstruction (DTR).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, continuous improvements in digestive tract reconstruction after proximal gastrectomy have yielded the development of a variety of methods with antireflux functions that contribute to retaining the function of the residual stomach and avoiding serious reflux esophagitis ( 8 – 10 ). Japanese guidelines indicate that popular methods for gastrointestinal reconstruction after proximal gastrectomy include esophagogastrotomy (EG), jejunal interposition (JI), and double-tract reconstruction (DTR) ( 11 – 13 ). In 2016, Kuroda reported a double-flap technique using the anterior gastric wall plasma muscle flap to cover the anastomosis ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

Study protocol for comparing the efficacy of left-open single-flap technique versus double-flap technique after proximal gastrectomy: A multicenter randomized controlled trial

Yang

Wang²,

Mo³

et al. 2022

Front. Oncol.

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BackgroundProximal gastrectomy has gradually gained more attention due to its superiority in retaining the function of part of the stomach. The inevitable loss of the antireflux barrier and postoperative complications resulting from proximal gastrectomy can severely affect the quality of life. Continuous improvements in digestive tract reconstruction after proximal gastrectomy have yielded the development of a variety of methods with antireflux functions. Recently, our center attempted the left-open single-flap technique and initiated a multicenter, prospective, randomized controlled trial for patients undergoing proximal gastrectomy to reduce the difficulty of surgical anastomosis and the incidence of perioperative complications compared with the double-flap technique. These findings will provide more evidence-based medical research for the development of clinical guidelines.Methods/designThis study is a prospective, multicenter, randomized controlled clinical trial. We plan to recruit 250 patients who are eligible for proximal gastrectomy. After informed consent is obtained, patients will be randomly assigned to the trial group (left-open single-flap technique) and the control group (double-flap technique) in a 1:1 allocation ratio.DiscussionIncreasingly, clinical studies have focused on the improvement of reconstruction modalities after proximal gastrectomy. Among these methods, the double-flap technique is a clinically effective method. The purpose of this study is to establish a prospective randomized controlled trial to compare the efficacy of the left-open single-flap technique versus the double-flap technique after proximal gastrectomy, aiming to provide more evidence-based medical studies for digestive tract reconstruction in proximal gastrectomy.Clinical Trial RegistrationClinicalTrials.gov, identifier [NCT05418920].

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Double tract reconstruction versus double flap technique: short-term clinical outcomes after laparoscopic proximal gastrectomy for early gastric cancer

Cited by 12 publications

References 28 publications

Laparoscopic Proximal Gastrectomy with Right-Sided Overlap and Single-Flap Valvuloplasty (ROSF): A Case-Series Study

Laparoscopic Proximal Gastrectomy with Right-Sided Overlap and Single-Flap Valvuloplasty (ROSF): A Case-Series Study

Laparoscopic proximal gastrectomy with right-sided overlap and single-flap valvuloplasty (ROSF): a case-series study

Study protocol for comparing the efficacy of left-open single-flap technique versus double-flap technique after proximal gastrectomy: A multicenter randomized controlled trial

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