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Published on: December 27, 2024
Laparoscopic proximal gastrectomy with esophagogastrostomy using overlap method combined with gastric remnant
Yu Zheng1, Jia Wang1, Chen Wang1
1Department of Gastrointestinal, Hernia and Abdominal Wall Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Objective:
Proximal gastrectomy (PG) is increasingly preferred over total gastrectomy for upper gastric cancer to preserve gastric function, yet postoperative reflux remains a critical challenge. The purpose of this study was to compare and analyze the clinical effects and quality of life following totally laparoscopic proximal gastrectomy with esophagogastrostomy using the overlap method combined with a gastric remnant "U" shaped fold (EGOUF) vs. conventional laparoscopic-assisted esophagogastrostomy.
Methods:
A retrospective cohort study was conducted involving 60 patients who underwent laparoscopic proximal gastrectomy between January 2023 and March 2025. According to the digestive tract reconstruction method, patients were divided into two groups: the EGOUF group and the non-EGOUF group, each comprising 30 cases. We evaluated the efficacy of the reconstruction method by observing perioperative outcomes, postoperative complications, and short-term nutritional status over a follow-up period of 3-6 months.
Results:
After 3 months, the incidence of reflux esophagitis in the EGOUF group was significantly lower than in the non-EGOUF group (6.7% vs. 86.7%, P < 0.001). The quality of life in the EGOUF group was superior, with significantly reduced acid reflux and heartburn symptoms (0% vs. 70.0%, P < 0.001). After 6 months, the EGOUF group demonstrated better nutritional preservation, including a higher total protein index [66.8 (64.7, 68.5) g/L vs. 62.2 ± 3.6 g/L, P < 0.001], higher vitamin B12 levels [566.3 ± 56.0 pg/mL vs. 500.0 (480.0, 532.0) pg/mL, P < 0.001], and less weight loss [3.75% ± 6.45% vs. 7.00% (5.00%, 14.00%), P = 0.003]. Other short-term nutritional indicators showed no significant differences. Furthermore, the EGOUF group experienced less intraoperative blood loss [15.0 [10.0, 20.0] mL vs. 50.0 [27.5, 50.0] mL, P < 0.001] and shorter postoperative hospital stays [9.0 [8.8, 10.3] days vs. 12.0 [10.0, 14.0] days, P = 0.001].
Conclusions:
The EGOUF technique offers a superior alternative for digestive tract reconstruction following laparoscopic proximal gastrectomy. Compared to the non-EGOUF group, patients undergoing EGOUF experienced significantly lower rates of reflux esophagitis, reduced intraoperative blood loss, quicker postoperative recovery, and better short-term nutritional status, leading to an improved quality of life.