Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Oct;18(4):850-8.
doi: 10.1007/s10120-014-0431-6. Epub 2014 Oct 16.

A Newly Modified Esophagogastrostomy With a Reliable Angle of His by Placing a Gastric Tube in the Lower Mediastinum in Laparoscopy-Assisted Proximal Gastrectomy

Affiliations

A Newly Modified Esophagogastrostomy With a Reliable Angle of His by Placing a Gastric Tube in the Lower Mediastinum in Laparoscopy-Assisted Proximal Gastrectomy

Atsushi Yasuda et al. Gastric Cancer. .

Abstract

Background: An optimal reconstruction method for proximal gastrectomy (PG) remains elusive. Esophagogastrostomy (EG) is technically simple but suffers from the disadvantage of gastroesophageal reflux. Jejunal interposition (JI) has a low rate of gastroesophageal reflux, but the procedure is more complicated, and delayed gastric emptying is a problem.

Methods: We created a modified EG and have used the modified technique for PG since 2006. The procedure involves shaping the remnant stomach into a gastric conduit. The EG is performed high on the anterior wall, and the conduit is kept straight by applying a circular stapler inserted from the anterior wall of the antrum. The tip of the gastric conduit is then inserted into the lower mediastinum, creating a sharp angle of His. In this retrospective cohort study, the clinical and physiological outcomes were compared between 25 patients who underwent this procedure and 21 patients who underwent JI from 2001 to 2005.

Results: Laparoscopic procedures were performed more frequently, and residual food and bile reflux were less common in the EG group than in the JI group. No significant differences in remnant gastritis or reflux esophagitis were observed between the two groups. However, the late complication of intestinal obstruction occurred only in the JI group.

Conclusions: The modified EG technique has advantages over the JI technique because of its simplicity and low incidence of residual food and bile reflux. The next step would be to explore this technique further by a prospective multi-institutional study to confirm the reproducibility of its benefits. Miniabstract: The modified EG technique has advantages over the JI technique because of its simplicity, high rate of laparoscopy use, and low incidence of gastroesophageal reflux.

Keywords: Esophagogastrostomy; Gastric tube; Proximal gastrectomy.

Similar articles

See all similar articles

Cited by 10 articles

See all "Cited by" articles

References

    1. Gastric Cancer. 2013 Jul;16(3):440-4 - PubMed
    1. World J Surg. 2002 Sep;26(9):1150-4 - PubMed
    1. Ann Surg Oncol. 2006 Feb;13(2):221-8 - PubMed
    1. Dis Esophagus. 2008;21(5):377-88 - PubMed
    1. Gastric Cancer. 2011 Jun;14(2):113-23 - PubMed

MeSH terms

LinkOut - more resources

Feedback