Case Report: A Novel Reconstruction Method (Itihaas's Anastomosis) for Proximal Gastrectomy

This study introduces a novel reconstruction method (Itihaas's Anastomosis) for the upper gastrointestinal (UGI) tract following proximal gastrectomy, designed to mitigate the severity of acid reflux syndrome, a frequent postoperative complication. The procedure comprises three side-to-side anastomoses: esophago-gastrostomy, gastro-jejunostomy, and jejuno-jejunostomy. The esophago-gastrostomy anastomosis aims to prevent direct reflux of gastric contents into the esophagus by creating a fundus-like structure, which also facilitates future endoscopic procedures. The gastro-jejunostomy reduces acid reflux by diverting gastric acid to the jejunum for further neutralization, while the jejuno-jejunostomy prevents bile and pancreatic juice reflux into the stomach. A 75-year-old male with adenocarcinoma of the upper stomach underwent this surgical procedure. Postoperative outcomes showed no major complications, with smooth oral contrast passage and no evidence of anastomotic leaks. The patient was discharged after resuming consumption of semi-solid food and experienced no signs of reflux. Itihaas's Anastomosis represents a novel technical approach that theoretically may reduce acid reflux following proximal gastrectomy. Initial case experience suggests technical feasibility, though all claimed benefits remain theoretical without objective validation. Long-term outcomes, anti-reflux efficacy, and comparative effectiveness require validation through systematic case series with objective assessments.