Reverse double-stapling end-to-end esophagogastrostomy in proximal gastrectomy

Proximal gastrectomy is a surgical option for proximally located early gastric cancer. We present a new double-stapling method for proximal gastrectomy and esophagogastrostomy.

We examined the safety of proximal gastrectomy by analyzing the lymph node metastasis rate in 53 patients who underwent total gastrectomy due to proximally located early gastric cancer from January 2004 to December 2008. We applied the double-stapling method used in distal gastrectomy reversely to proximal gastrectomy and esophagogastrostomy in 15 patients.

Retrospective analysis showed that proximal early gastric cancer metastasizes to only lymph node station 2, 3 and 7 which were completely removed during proximal gastrectomy. Fifteen patients underwent proximal gastrectomy using a new method which left no gastrostomy wound for the insertion of a circular stapler in the remaining stomach. The median operation time was 156.5 min and median postoperative hospital stay was 8.0 days. There were only 2 cases of wound complications during hospital stay. Two cases of anastomosis site strictures which developed after discharge were successfully treated with balloon dilatation.

We presented a new 'reverse double-stapling method' for proximal gastrectomy, which seems to be a fast and feasible method that leaves no gastrostomy wound in the remaining stomach.