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Single Incision Plus One Port Laparoscopic Proximal Gastrectomy with Double Channel Anastomosis for Gastric Cancer Treatment
Published on: December 27, 2024
Trapezoidal tunnel intracorporeal esophagogastric anastomosis technique in laparoscopic-assisted proximal
Nobuyuki Sakurazawa1,2, Daisuke Kakinuma3, Nobutoshi Hagiwara4
1Department of Gastroenterological Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan. nsakuraz@nms.ac.jp.
Background:
Proximal gastrectomy (PG) is a curative surgical option that can also improve quality of life. Although esophagogastric anastomosis is a simple one-site procedure, reflux esophagitis remains a concern. This study presents an esophagogastric anastomosis technique that simplifies intra-abdominal manipulation by forming a trapezoidal tunnel in the residual stomach through extra-abdominal manipulation. We then evaluated the feasibility and functional outcomes of this technique.
Methods:
We retrospectively analyzed clinical data from 12 consecutive patients who underwent laparoscopic PG using the trapezoidal tunnel technique between November 2017 and September 2020 at Nippon Medical School Chiba Hokuso Hospital and between October 2020 and May 2022 at Nippon Medical School Hospital. Demographic and clinical pathological characteristics, preoperative details, and postoperative outcomes were analyzed. Reflux and stenosis status was assessed via endoscopy during follow-up conducted at least 1 year after surgery.
Results:
Laparoscopic PG using the trapezoidal tunnel technique was successfully performed in all 12 cases. The mean operative time was 262 (195-362) minutes (including 57 [40-89] minutes for reconstruction). No postoperative complications of Clavien-Dindo grade II or higher were observed. The mean hospital stay was 12 (10-21) days. Endoscopic findings during postoperative follow-up (61 [14-89 months]) were normal, except for one patient who developed Los Angeles classification grade A esophagitis. Notably, no anastomotic strictures were identified.
Conclusion:
The trapezoidal tunnel technique is a feasible approach for anti-reflux reconstruction following laparoscopic PG that simplifies intra-abdominal surgical techniques while maintaining favorable postoperative clinical outcomes. Given the retrospective nature of the cases analyzed, further large-scale clinical trials are essential to verify the safety and efficacy of this technique.