Pang Li-Qun, Zhang Jie, Shi Fang, Pang Cong, Zhang Cheng-Wan, Liu Ye-Liu, Zhao Yao, Qian Yan, Li Xiang-Wei, Kong Dan, Wu Shang-Nong, Zhou Jing-Fang, Xie Cong-Xue, Chen Song
Department of General Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China.
Jiangsu Key Laboratory of Advanced Manufacturing Technology, Huaiyin Institute of Technology, Huaian 223300, Jiangsu Province, China.
World J Gastrointest Surg. 2023 Aug 27;15(8):1761-1773. doi: 10.4240/wjgs.v15.i8.1761.
Reflux esophagitis is a common postoperative complication of proximal gastrectomy. There is an urgent need for a safer method of performing esophageal-gastric anastomosis that reduces the risk of reflux after proximal gastrectomy. We hypothesize that a novel technique termed esophagogastric asymmetric anastomosis (EGAA) can prevent postoperative reflux in a safe and feasible manner.
To observe a novel method of EGAA to prevent postoperative reflux.
Initially, we employed a thermal stress computer to simulate and analyze gastric peristalsis at the site of an esophagogastric asymmetric anastomosis. This was done in order to better understand the anti-reflux function and mechanism. Next, we performed digestive tract reconstruction using the EGAA technique in 13 patients who had undergone laparoscopic proximal gastrectomy. Post-surgery, we monitored the structure and function of the reconstruction through imaging exams and gastroscopy. Finally, the patients were followed up to assess the efficacy of the anti-reflux effects.
Our simulation experiments have demonstrated that the clockwise contraction caused by gastric peristalsis and the expansion of the gastric fundus caused by the increase of intragastric pressure could significantly tighten the anastomotic stoma, providing a means to prevent the reverse flow of gastric fluids. Thirteen patients with esophagogastric junction tumors underwent laparoscopic proximal gastrectomy, with a mean operation time of 304.2 ± 44.3 min. After the operation, the upper gastroenterography in supine/low head positions showed that eight patients exhibited no gastroesophageal reflux, three had mild reflux, and two had obvious reflux. The abdominal computed tomography examination showed a valve-like structure at the anastomosis. During follow-up, gastroscopy revealed a closed valve-like form at the anastomosis site without stenosis or signs of reflux esophagitis in 11 patients. Only two patients showed gastroesophageal reflux symptoms and mild reflux esophagitis and were treated with proton pump inhibitor therapy.
EGAA is a feasible and safe surgical method, with an excellent anti-reflux effect after proximal gastrectomy.
反流性食管炎是近端胃切除术后常见的并发症。迫切需要一种更安全的食管胃吻合方法，以降低近端胃切除术后反流的风险。我们假设一种名为食管胃不对称吻合术（EGAA）的新技术能够以安全可行的方式预防术后反流。
观察EGAA预防术后反流的新方法。
首先，我们使用热应激计算机对食管胃不对称吻合部位的胃蠕动进行模拟和分析。这样做是为了更好地理解抗反流功能及机制。接下来，我们对13例接受腹腔镜近端胃切除术的患者采用EGAA技术进行消化道重建。术后，我们通过影像学检查和胃镜监测重建的结构和功能。最后，对患者进行随访以评估抗反流效果。
我们的模拟实验表明，胃蠕动引起的顺时针收缩以及胃内压升高导致的胃底扩张可显著收紧吻合口，为防止胃液逆流提供了一种手段。13例食管胃交界肿瘤患者接受了腹腔镜近端胃切除术，平均手术时间为304.2±44.3分钟。术后，仰卧/低头位上消化道造影显示，8例患者无胃食管反流，3例有轻度反流，2例有明显反流。腹部计算机断层扫描检查显示吻合处有瓣膜样结构。随访期间，胃镜检查发现11例患者吻合口处呈闭合瓣膜样形态，无狭窄或反流性食管炎迹象。仅2例患者出现胃食管反流症状和轻度反流性食管炎，接受了质子泵抑制剂治疗。
EGAA是一种可行且安全的手术方法，近端胃切除术后具有出色的抗反流效果。
