Advertisement

Comparison of double-flap and OrVil techniques of laparoscopy-assisted proximal gastrectomy in preventing gastroesophageal reflux: a retrospective cohort study

  • Kei Hosoda
  • Marie Washio
  • Hiroaki Mieno
  • Hiromitsu Moriya
  • Akira Ema
  • Hideki Ushiku
  • Masahiko Watanabe
  • Keishi Yamashita
ORIGINAL ARTICLE
  • 45 Downloads

Abstract

Background

Laparoscopy-assisted proximal gastrectomy (LAPG) with esophagogastrostomy using the double-flap technique has been reported to rarely cause gastroesophageal reflux. However, quantitative evaluation of the reflux has hardly been performed. The aim of this study was to clarify the superiority of the double-flap technique of LAPG with esophagogastrostomy compared with the OrVil technique in terms of preventing gastroesophageal reflux.

Methods

A total of 40 and 51 patients who underwent LAPG with esophagogastrostomy using the double-flap and OrVil techniques, respectively, for upper one-third gastric cancer were included in this study. Of these, 22 and 13 patients in the double-flap and OrVil groups, respectively, consented to undergo a 24-h impedance-pH monitoring test at 3 months postoperatively. Postoperative complications, including gastroesophageal reflux and anastomotic stricture, were assessed retrospectively.

Results

No significant differences were observed in the patients’ background between both groups, except for a higher D1+ dissection rate observed in double-flap group than in the OrVil group (93% vs 25%, P < 0.001). Operative time was significantly longer in the double-flap group than in the OrVil group (353 min vs 280 min, P < 0.001). All reflux % time was significantly lower in the double-flap group than in the OrVil group (1.29% vs 2.62%, P = 0.043). On the other hand, the proportion of anastomotic stricture requiring endoscopic balloon dilatation was lower in the double-flap group than in the OrVil group but without statistical significance (18% vs 27%; P = 0.32).

Conclusions

Despite its longer operative time and still relatively high anastomotic stricture rate, the double-flap technique would be better than the OrVil technique in terms of preventing gastroesophageal reflux in patients who underwent LAPG with esophagogastrostomy.

Keywords

Laparoscopic surgery Proximal gastrectomy Esophagogastrostomy Gastroesophageal reflux Anastomotic stricture 

Notes

Acknowledgements

We would like to thank Editage (www.editage.jp) for English language editing.

Compliance with ethical standards

This study was conducted in accordance with the 1995 Declaration of Helsinki (as revised in Brazil 2013) and was approved by the Kitasato University School of Medicine Research Ethics Committee. The requirement for informed consent was waived because of the study’s retrospective design. The manuscript was written according to the STROBE Statement.

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

References

  1. 1.
    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E359–E386.  https://doi.org/10.1002/ijc.29210 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Nashimoto A, Akazawa K, Isobe Y, Miyashiro I, Katai H, Kodera Y, Tsujitani S, Seto Y, Furukawa H, Oda I, Ono H, Tanabe S, Kaminishi M (2013) Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry. Gastric Cancer 16(1):1–27.  https://doi.org/10.1007/s10120-012-0163-4 CrossRefPubMedGoogle Scholar
  3. 3.
    Hosoda K, Yamashita K, Katada N, Moriya H, Mieno H, Shibata T, Sakuramoto S, Kikuchi S, Watanabe M (2016) Potential benefits of laparoscopy-assisted proximal gastrectomy with esophagogastrostomy for cT1 upper-third gastric cancer. Surg Endosc 30(8):3426–3436.  https://doi.org/10.1007/s00464-015-4625-8 CrossRefPubMedGoogle Scholar
  4. 4.
    Kosuga T, Ichikawa D, Komatsu S, Okamoto K, Konishi H, Shiozaki A, Fujiwara H, Otsuji E (2015) Feasibility and nutritional benefits of laparoscopic proximal gastrectomy for early Gastric Cancer in the upper stomach. Ann Surg Oncol 22(Suppl 3):S929–S935.  https://doi.org/10.1245/s10434-015-4590-4 CrossRefPubMedGoogle Scholar
  5. 5.
    Zhao P, Xiao SM, Tang LC, Ding Z, Zhou X, Chen XD (2014) Proximal gastrectomy with jejunal interposition and TGRY anastomosis for proximal gastric cancer. World J Gastroenterol 20(25):8268–8273.  https://doi.org/10.3748/wjg.v20.i25.8268 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, Yamaue H, Yoshikawa T, Kojima K (2010) Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13(4):238–244.  https://doi.org/10.1007/s10120-010-0565-0 CrossRefPubMedGoogle Scholar
  7. 7.
    Katai H, Mizusawa J, Katayama H, Takagi M, Yoshikawa T, Fukagawa T, Terashima M, Misawa K, Teshima S, Koeda K, Nunobe S, Fukushima N, Yasuda T, Asao Y, Fujiwara Y, Sasako M (2017) Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan clinical oncology group study JCOG0912. Gastric Cancer 20(4):699–708.  https://doi.org/10.1007/s10120-016-0646-9 CrossRefPubMedGoogle Scholar
  8. 8.
    Sakuramoto S, Yamashita K, Kikuchi S, Futawatari N, Katada N, Watanabe M, Okutomi T, Wang G, Bax L (2013) Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term clinical outcomes of a randomized clinical trial. Surg Endosc 27(5):1695–1705.  https://doi.org/10.1007/s00464-012-2658-9 CrossRefPubMedGoogle Scholar
  9. 9.
    Hosoda K, Yamashita K, Moriya H, Mieno H, Ema A, Washio M, Watanabe M (2017) Laparoscopically assisted proximal gastrectomy with Esophagogastrostomy using a novel “open-door” technique : LAPG with novel reconstruction. J Gastrointest Surg 21(7):1174–1180.  https://doi.org/10.1007/s11605-016-3341-6 CrossRefPubMedGoogle Scholar
  10. 10.
    Kuroda S, Nishizaki M, Kikuchi S, Noma K, Tanabe S, Kagawa S, Shirakawa Y, Fujiwara T (2016) Double-flap technique as an Antireflux procedure in Esophagogastrostomy after proximal gastrectomy. J Am Coll Surg 223(2):e7–e13.  https://doi.org/10.1016/j.jamcollsurg.2016.04.041 CrossRefPubMedGoogle Scholar
  11. 11.
    Muraoka A, Kobayashi M, Kokudo Y (2016) Laparoscopy-assisted proximal gastrectomy with the hinged double flap method. World J Surg 40(10):2419–2424.  https://doi.org/10.1007/s00268-016-3510-5 CrossRefPubMedGoogle Scholar
  12. 12.
    Hayami M, Hiki N, Nunobe S, Mine S, Ohashi M, Kumagai K, Ida S, Watanabe M, Sano T, Yamaguchi T (2017) Clinical outcomes and evaluation of laparoscopic proximal gastrectomy with double-flap technique for early Gastric Cancer in the upper third of the stomach. Ann Surg Oncol 24(6):1635–1642.  https://doi.org/10.1245/s10434-017-5782-x CrossRefPubMedGoogle Scholar
  13. 13.
    Shibasaki S, Suda K, Nakauchi M, Kikuchi K, Kadoya S, Ishida Y, Inaba K, Uyama I (2017) Robotic valvuloplastic esophagogastrostomy using double flap technique following proximal gastrectomy: technical aspects and short-term outcomes. Surg Endosc 31(10):4283–4297.  https://doi.org/10.1007/s00464-017-5489-x CrossRefPubMedGoogle Scholar
  14. 14.
    Japanese Gastric Cancer A (1998) Japanese classification of Gastric carcinoma - 2nd English edition. Gastric Cancer 1(1):10–24.  https://doi.org/10.1007/s101209800016 CrossRefGoogle Scholar
  15. 15.
    Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14(2):113–123.  https://doi.org/10.1007/s10120-011-0042-4 CrossRefGoogle Scholar
  16. 16.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefGoogle Scholar
  17. 17.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196.  https://doi.org/10.1097/SLA.0b013e3181b13ca2 CrossRefPubMedGoogle Scholar
  18. 18.
    Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM (2011) Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc 25(3):855–860.  https://doi.org/10.1007/s00464-010-1281-x CrossRefPubMedGoogle Scholar
  19. 19.
    Lind T, Cederberg C, Ekenved G, Haglund U, Olbe L (1983) Effect of omeprazole--a gastric proton pump inhibitor--on pentagastrin stimulated acid secretion in man. Gut 24(4):270–276CrossRefGoogle Scholar
  20. 20.
    Jobe BA, Richter JE, Hoppo T, Peters JH, Bell R, Dengler WC, DeVault K, Fass R, Gyawali CP, Kahrilas PJ, Lacy BE, Pandolfino JE, Patti MG, Swanstrom LL, Kurian AA, Vela MF, Vaezi M, DeMeester TR (2013) Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the esophageal diagnostic advisory panel. J Am Coll Surg 217(4):586–597.  https://doi.org/10.1016/j.jamcollsurg.2013.05.023 CrossRefPubMedGoogle Scholar
  21. 21.
    Richter JE, Bradley LA, DeMeester TR, Wu WC (1992) Normal 24-hr ambulatory esophageal pH values. Dig Dis Sci 37(6):849–856CrossRefGoogle Scholar
  22. 22.
    Shay S, Tutuian R, Sifrim D, Vela M, Wise J, Balaji N, Zhang X, Adhami T, Murray J, Peters J, Castell D (2004) Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol 99(6):1037–1043.  https://doi.org/10.1111/j.1572-0241.2004.04172.x CrossRefPubMedGoogle Scholar
  23. 23.
    Dimenas E, Glise H, Hallerback B, Hernqvist H, Svedlund J, Wiklund I (1993) Quality of life in patients with upper gastrointestinal symptoms. An improved evaluation of treatment regimens? Scand J Gastroenterol 28(8):681–687CrossRefGoogle Scholar
  24. 24.
    Aihara R, Mochiki E, Ohno T, Yanai M, Toyomasu Y, Ogata K, Ando H, Asao T, Kuwano H (2010) Laparoscopy-assisted proximal gastrectomy with gastric tube reconstruction for early gastric cancer. Surg Endosc 24(9):2343–2348.  https://doi.org/10.1007/s00464-010-0947-8 CrossRefPubMedGoogle Scholar
  25. 25.
    Hiki N, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, Ohyama S, Seto Y, Muto T (2007) Laparoscopic esophagogastric circular stapled anastomosis: a modified technique to protect the esophagus. Gastric Cancer 10(3):181–186.  https://doi.org/10.1007/s10120-007-0433-8 CrossRefPubMedGoogle Scholar
  26. 26.
    Takeuchi H, Oyama T, Kamiya S, Nakamura R, Takahashi T, Wada N, Saikawa Y, Kitagawa Y (2011) Laparoscopy-assisted proximal gastrectomy with sentinel node mapping for early gastric cancer. World J Surg 35(11):2463–2471.  https://doi.org/10.1007/s00268-011-1223-3 CrossRefPubMedGoogle Scholar
  27. 27.
    Wang S, Lin S, Wang H, Yang J, Yu P, Zhao Q, Li M (2018) Reconstruction methods after radical proximal gastrectomy: a systematic review. Medicine (Baltimore) 97(11):e0121.  https://doi.org/10.1097/md.0000000000010121 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryKitasato University School of MedicineSagamiharaJapan
  2. 2.Division of Advanced Surgical Oncology, Research and Development Center for New Medical FrontiersKitasato University School of MedicineSagamiharaJapan

Personalised recommendations