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Double-tract reconstruction after laparoscopic proximal gastrectomy using detachable ENDO-PSD
Tomoki Aburatani1, Kazuyuki Kojima2, Sho Otsuki3
1Department of Gastric Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan. abrsrg2@tmd.ac.jp.
Surgical Endoscopy
|April 9, 2017
Summary
Double-tract reconstruction (DTR) after proximal gastrectomy (PG) significantly reduces reflux symptoms and strictures compared to esophagogastrostomy (EG). This laparoscopic DTR method offers a superior functional outcome for patients undergoing PG.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Proximal gastrectomy (PG) is a common function-preserving surgery in Japan.
- Esophagogastrostomy (EG) reconstruction is linked to increased reflux and strictures.
- Double-tract reconstruction (DTR) has become the preferred method since 2013.
Purpose of the Study:
- To describe a novel laparoscopic DTR technique using detachable ENDO-PSD.
- To compare the 1-year outcomes of laparoscopic DTR with conventional EG after PG.
Main Methods:
- Retrospective analysis of 41 patients undergoing laparoscopic PG (19 DTR, 22 EG).
- Detailed description of the laparoscopic DTR technique including intracorporeal suturing.
- Comparison of patient characteristics, operative data, complications, and 1-year follow-up outcomes.
Main Results:
- Significantly lower rates of reflux symptoms (10.5% vs. 54.5%) and anastomotic strictures (0% vs. 27%) in the DTR group.
- Reduced proton pump inhibitor usage in the DTR group (31.6% vs. 72.7%).
- No significant differences in operation time, blood loss, hospital stay, or other postoperative parameters.
Conclusions:
- Laparoscopic DTR is an effective reconstruction method following PG.
- DTR significantly reduces the incidence of reflux esophagitis and anastomotic strictures.
- This technique offers improved functional outcomes for patients undergoing PG.