Abstract
Background
Compared with total gastrectomy, proximal gastrectomy (PG) has potential advantages from a nutritional perspective, such as anemia and postoperative loss of body weight. However, PG is associated with some postoperative functional disorders, such as reflux esophagus (13–31%) and anastomotic stenosis (3–29%).1 We therefore developed a new procedure for fundoplication during esophago-gastrostomy after robotic PG (RPG).
Methods
We performed RPG for early gastric cancer localized in the upper third of the stomach using the da Vinci Surgical System (Intuitive, Sunnyvale, CA). After RPG conclusion, intracorporeal esophago-gastrostomy was performed by side-to-side anastomosis using a linear 45 mm stapling device, Endo GIA purple cartridge.2 The post-excisional hole in the esophago-gastrostomy was closed with interrupted single-layered sutures by robotic suturing technique. Fundoplication was created by wrapping the remnant stomach around 180 degrees of the circumference of the esophagus; the remnant stomach was wrapped from the esophageal posterior wall towards the esophageal anterior wall. Four stitches were used for fixation. We did not add a bougie of esophago-gastrostomy when fashioning the wrap. In addition, we did not perform pyloroplasty.
Results
In our series with 15 patients, there were no postoperative complications. No patients had reflux symptoms. Our technique using the fundoplication with “clockwise” rotation attempts to prevent reflux by use of intragastric pressure to flatten the lower end of the esophagus into a valvate shape. Indeed, in fluoroscopic findings 4 days after surgery, there was no reflux to the esophagus of the contrast medium. In endoscopic findings 3 months after surgery, anastomotic stenosis was absent. We observed no endoscopic findings of reflux esophagitis. Formation of the pseudo-fornix was confirmed by wrapping the remnant stomach.
Conclusions
RPG followed by fundoplication with 180-degree wrap may be a promising procedure for reflux esophagitis prevention.3,4 However, long-term follow-up is required to show benefits of this new procedure.4
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References
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Authors and Affiliations
Contributions
Study concept and design: Ojima and Yamaue
Acquisition of data: Ojima, Nakamori, Nakamura, and Maruoka
Drafting of the manuscript: Ojima, Nakamura, Hayata, and Maruoka
Critical revision of the manuscript for important intellectual content: Yamaue
Administrative, technical, and material support: Nakamori, Hayata, and Yamaue
Study supervision: Yamaue
Corresponding author
Ethics declarations
This study was approved by the Institutional Review Board and the Ethics Committee of Wakayama Medical University. The study protocol was registered at the University Hospital Medical Information Network (UMIN000027969).
Conflict of Interest
The authors declare that they have no conflict of interest.
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Ojima, T., Nakamori, M., Nakamura, M. et al. Fundoplication with 180-Degree Wrap During Esophagogastrostomy After Robotic Proximal Gastrectomy for Early Gastric Cancer. J Gastrointest Surg 22, 1475–1476 (2018). https://doi.org/10.1007/s11605-018-3765-2
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DOI: https://doi.org/10.1007/s11605-018-3765-2