Wang Ze-Qin, Cui Wen-Liang, Zhu Yan-Feng, Ma Ming-Ye, Wang Jian, Wang Zi-Hao, Wang Ya-Ping, Hong Jun, Hao Han-Kun
Division of Gastrointestinal Surgery, Department of General Surgery, Huashan Hospital, Fudan University, NO.12, Wulumuqi Middle Road, Shanghai, China.
Department of Nursing, Huashan Hospital, Fudan University, NO.12, Wulumuqi Middle Road, Shanghai, China.
World J Surg Oncol. 2025 Jul 3;23(1):263. doi: 10.1186/s12957-025-03900-4.
For adenocarcinoma localized at the gastroesophageal junction and the upper third of the stomach, proximal gastrectomy (PG) is a commonly used surgical method that preserves gastric function. For reconstruction after PG, an effective anti-reflux technique is crucial. This study proposes a novel fundoplication and valvuloplasty esophagogastrostomy technique, named as Hao's esophagogastrostomy by fissure technique (HEFT).
A retrospective analysis was conducted on the clinical data of 11 consecutive cases that underwent totally laparoscopic proximal gastrectomy with HEFT at Huashan Hospital, Fudan University from September 2021 to January 2024. The demographics and clinics pathologic profiles, preoperative details, and postoperative outcomes of the patients were analyzed. And the reflux conditions were evaluated 6 months after surgery by endoscopy.
All 11 patients successfully underwent the totally laparoscopic surgery. The operative time was 190 (150, 240) minutes, including a reconstruction duration of 30 (25, 30) minutes. No Clavien-Dindo grade II or higher complications occurred postoperatively, and the hospital stay was 6 (5, 7) days. Endoscopic findings at 6 months postoperatively indicated 2 cases of LA grade A esophagitis. Among them, 1 patient experienced reflux symptoms after overeating, which improved after using proton pump inhibitor drugs. Notably, there were no occurrences of anastomotic stenosis.
HEFT presents a promising approach for anti-reflux reconstruction following proximal gastrectomy (PG), simplifying the surgical technique while maintaining favorable immediate clinical outcomes. However, given that this is a retrospective study, further research with larger-scale clinical trials and long-term follow-up is essential to validate its safety, efficacy, and long-term benefits.
对于位于胃食管交界处和胃上三分之一的腺癌，近端胃切除术（PG）是一种常用的保留胃功能的手术方法。PG术后重建时，有效的抗反流技术至关重要。本研究提出了一种新的胃底折叠术和瓣膜成形术食管胃吻合技术，即郝氏裂沟法食管胃吻合术（HEFT）。
对2021年9月至2024年1月在复旦大学附属华山医院连续11例行完全腹腔镜下近端胃切除术并采用HEFT的患者的临床资料进行回顾性分析。分析患者的人口统计学和临床病理特征、术前详细情况及术后结果。术后6个月通过内镜评估反流情况。
11例患者均成功完成完全腹腔镜手术。手术时间为190（150，240）分钟，其中重建时间为30（25，30）分钟。术后无Clavien-Dindo二级及以上并发症发生，住院时间为6（5，7）天。术后6个月内镜检查发现2例洛杉矶A级食管炎。其中1例患者在暴饮暴食后出现反流症状，使用质子泵抑制剂药物后症状改善。值得注意的是，未发生吻合口狭窄。
HEFT为近端胃切除术后抗反流重建提供了一种有前景的方法，简化了手术技术，同时保持了良好的近期临床效果。然而，鉴于这是一项回顾性研究，需要进一步开展大规模临床试验和长期随访研究，以验证其安全性、有效性和长期效益。
