Modified side overlap esophagogastrostomy after laparoscopic proximal gastrectomy

Abstract

We report a new method of esophagogastrostomy after proximal gastrectomy, side overlap with fundoplication by Yamashita (SOFY) in 2017. Recently, even better treatment results can be obtained by modifying the SOFY method. We describe the technical details of the modified SOFY (mSOFY) after laparoscopic proximal gastrectomy. The stomach was dissected in the short axis direction and the esophagus was dissected in the left and right direction. After the proximal gastrectomy, the bilateral diaphragmatic crus were dissected to enhance gastric elevation. After confirming that the esophagus overlapped more than 5 cm at the center of the remnant stomach (we call it SOFY check), the remnant stomach was suture‐fixed to the dissected diaphragmatic crus. The right wall of the esophageal stump and the remnant stomach were anastomosed using the full length of a 45 mm‐linear stapler. The entry hole was closed in a direction that did not widen the anastomotic hole. Both sides of the esophagus, remnant stomach, and diaphragmatic crus were suture‐fixed on the cranial side 1–2 cm away from the anastomosis. Moreover, the left wall and lower end of the esophagus was suture‐fixed to the remnant stomach. The preserved dorsal esophageal wall is pressed and flattened by pressure from the pseudofornix, which is the reflux prevention mechanism. The mSOFY method had favorable treatment outcomes. In conclusion, mSOFY can be one of the safe and feasible reconstruction methods after laparoscopic proximal gastrectomy.

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

“…On the other hand, SOFY was reported to have lower rate of anastomotic stenosis (2.8%) [15]. Interestingly, none of our patients had anastomotic stenosis within follow-up period according to Nishikawa's criterion [12].…”

“…To overcome this, various techniques have been designed, among which DFT had the lowest incidence of re ux esophagitis (0-8.3%) [7]. SOFY was also reported to have lower incidence of re ux esophagitis (17.9%), but higher than DFT [15]. Compared with the previous methods, it is encouraging that only one (5%) of our initial 20 patients had mild symptoms of re ux (Visick score = II) and endoscopic re ux esophagitis of LA Grade A was observed in only one patient (5%).…”

“…Theoretically, ROSF may reduce the possibility of leakage better than SOFY, since the anastomosis is covered by the ap, though anastomotic leakage was not reported in SOFY [15]. Based on the considerations above, ROSF might have some advantages in preventing anastomotic stenosis and leakage.…”

Laparoscopic Function-Preserving Gastrectomy for Proximal Gastric Cancer or Esophagogastric Junction Cancer: A Narrative Review

“…Hence, anastomosis using a linear stapler that can prevent stenosis and reflux will be a common method for LPG-EG if favorable long-term surgical results are obtained. In LPG-non-DFT using a linear stapler, the median or mean surgery times were less than 6 h [32,34,35]. BWL was 7.4% in the postoperative period [32].…”

“…Ahn et al reported that the incidence of stenosis was significantly higher in an endto-end EG with a circular stapler than in a side-to-side EG with a liner stapler (46.2% vs. 0%, p < 0.001) [33]. Yamashita also reported that side overlap EG using a linear stapler with fundoplication, namely the side overlap with fundoplication by Yamashita (SOFY) method, was effective to avoid stenosis, leakage, and reflux esophagitis in comparison to EG with a circular stapler [32,34]. In the SOFY method, the left side of the esophageal wall is anastomosed with the anterior gastric wall using linear stapler and the right side of the esophageal wall is stuck to the gastric wall, which causes the preserved dorsal esophageal wall to be pressed and flattened into a valvate shape by pressure from the artificial fundus to form the reflux prevention mechanism [32].…”