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Vagus nerve preservation and double-flap technique in laparoscopic proximal gastrectomy
Ke-Kang Sun1,2, Xiao-Jun Shen1, Peng Hua1
1Department of Gastrointestinal Surgery, Affiliated Kunshan Hospital to Jiangsu University, Suzhou, Jiangsu, China.
Frontiers in Surgery
|December 8, 2025
Summary
This study modified the double-flap technique for laparoscopic proximal gastrectomy, preserving vagus nerves to prevent reflux esophagitis in early gastric cancer patients. The modified technique showed promising results with minimal complications.
Area of Science:
- Gastroenterology and Surgical Oncology
Background:
- Laparoscopic proximal gastrectomy is a standard treatment for early gastric cancer.
- The conventional double-flap technique (DFT) may compromise quality of life due to lack of vagus nerve preservation.
- Vagus nerve preservation is crucial for preventing postoperative reflux esophagitis.
Purpose of the Study:
- To evaluate the safety and efficacy of a modified double-flap technique (DFT) with vagus nerve preservation for laparoscopic proximal gastrectomy.
- To assess the prevention of postoperative reflux esophagitis and impact on quality of life.
Main Methods:
- A single-center retrospective analysis of 37 patients undergoing laparoscopic proximal gastrectomy with vagus nerve preservation and modified DFT.
- Preservation of hepatic and celiac branches of the vagus nerve.
- Creation of a seromuscular double-flap and laparoscopic anastomosis.
Main Results:
- A low incidence of anastomotic stricture (2.7%) with successful conservative management.
- No anastomotic bleeding or leakage observed.
- Absence of food residue and significant GERD (Los Angeles grade B or higher) at 6 months post-surgery.
- Normal gallbladder contractile function in all patients.
Conclusions:
- The modified double-flap technique with vagus nerve preservation is a safe and effective minimally invasive option for proximal early gastric cancer.
- This approach shows potential in preventing postoperative reflux esophagitis.
- Further long-term studies with larger cohorts are needed to confirm functional outcomes.
