Kurokawa Yukinori, Saito Takuro, Yamamoto Kazuyoshi, Takahashi Tsuyoshi, Doki Yuichiro
Department of Gastroenterological Surgery Osaka University Graduate School of Medicine Osaka Japan.
Ann Gastroenterol Surg. 2024 Sep 17;9(1):205-210. doi: 10.1002/ags3.12859. eCollection 2025 Jan.
Several reconstruction methods are used in proximal gastrectomy. Esophagogastrostomy is the simplest and most physiological. The challenge in esophagogastrostomy is preventing reflux esophagitis. Various techniques have been developed to reduce reflux of gastric juice. Taking advantage of the usefulness of the recently reported modified side overlap with fundoplication by Yamashita (mSOFY) method, we developed a y-shaped mSOFY method that is simpler and has potential for a greater anti-reflux effect. Unlike the original mSOFY method, the pseudo-fornix does not go behind the esophagus and the axes of the esophagus and residual stomach are shifted by approximately 60° to form a "y" shape. In addition, fixation of the residual stomach and both sides of the esophagus and crus of the diaphragm is performed at the end of the procedure. We performed 12 cases of laparoscopic or robotic proximal gastrectomy with y-shaped mSOFY esophagogastric anastomosis located below the crus of the diaphragm for gastric or esophagogastric junction adenocarcinoma between August 2021 and March 2023. The median operative time and blood loss were 260 min and 5 mL, respectively. No postoperative complications of Clavien-Dindo classification grade II or higher occurred. No stenoses requiring balloon dilation occurred within 1 year after surgery, but endoscopy at 1 year after surgery revealed two cases (17%) of reflux esophagitis of Los Angeles grade B or higher. In conclusion, this y-shaped side overlap esophagogastrostomy method could be one of the recommended esophagogastrostomy procedures in proximal gastrectomy.
近端胃切除术有多种重建方法。食管胃吻合术是最简单且最符合生理的。食管胃吻合术面临的挑战是预防反流性食管炎。已开发出各种技术来减少胃液反流。利用最近报道的山下改良侧方重叠加胃底折叠术（mSOFY）的有效性，我们开发了一种更简单且具有更大抗反流效果潜力的y形mSOFY方法。与原始的mSOFY方法不同，假穹窿不经过食管后方，食管和残胃的轴线大约偏移60°以形成“y”形。此外，在手术结束时对残胃、食管两侧以及膈肌脚进行固定。2021年8月至2023年3月期间，我们对12例胃或食管胃交界腺癌患者进行了腹腔镜或机器人辅助近端胃切除术，采用位于膈肌脚下方的y形mSOFY食管胃吻合术。中位手术时间和失血量分别为260分钟和5毫升。未发生Clavien-Dindo分类二级或更高等级的术后并发症。术后1年内未出现需要球囊扩张的狭窄，但术后1年的内镜检查发现2例（17%）洛杉矶分级为B级或更高的反流性食管炎。总之，这种y形侧方重叠食管胃吻合术方法可能是近端胃切除术中推荐的食管胃吻合术式之一。
