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Comparison of double-flap and OrVil techniques of laparoscopy-assisted proximal gastrectomy in preventing gastroesophageal reflux: a retrospective cohort study

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Abstract

Background

Laparoscopy-assisted proximal gastrectomy (LAPG) with esophagogastrostomy using the double-flap technique has been reported to rarely cause gastroesophageal reflux. However, quantitative evaluation of the reflux has hardly been performed. The aim of this study was to clarify the superiority of the double-flap technique of LAPG with esophagogastrostomy compared with the OrVil technique in terms of preventing gastroesophageal reflux.

Methods

A total of 40 and 51 patients who underwent LAPG with esophagogastrostomy using the double-flap and OrVil techniques, respectively, for upper one-third gastric cancer were included in this study. Of these, 22 and 13 patients in the double-flap and OrVil groups, respectively, consented to undergo a 24-h impedance-pH monitoring test at 3 months postoperatively. Postoperative complications, including gastroesophageal reflux and anastomotic stricture, were assessed retrospectively.

Results

No significant differences were observed in the patients’ background between both groups, except for a higher D1+ dissection rate observed in double-flap group than in the OrVil group (93% vs 25%, P < 0.001). Operative time was significantly longer in the double-flap group than in the OrVil group (353 min vs 280 min, P < 0.001). All reflux % time was significantly lower in the double-flap group than in the OrVil group (1.29% vs 2.62%, P = 0.043). On the other hand, the proportion of anastomotic stricture requiring endoscopic balloon dilatation was lower in the double-flap group than in the OrVil group but without statistical significance (18% vs 27%; P = 0.32).

Conclusions

Despite its longer operative time and still relatively high anastomotic stricture rate, the double-flap technique would be better than the OrVil technique in terms of preventing gastroesophageal reflux in patients who underwent LAPG with esophagogastrostomy.

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Acknowledgements

We would like to thank Editage (www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, 252-0374, Japan

    Kei Hosoda, Marie Washio, Hiroaki Mieno, Hiromitsu Moriya, Akira Ema, Hideki Ushiku, Masahiko Watanabe & Keishi Yamashita

  2. Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan

    Keishi Yamashita

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  1. Kei Hosoda
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Correspondence to Kei Hosoda.

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This study was conducted in accordance with the 1995 Declaration of Helsinki (as revised in Brazil 2013) and was approved by the Kitasato University School of Medicine Research Ethics Committee. The requirement for informed consent was waived because of the study’s retrospective design. The manuscript was written according to the STROBE Statement.

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Hosoda, K., Washio, M., Mieno, H. et al. Comparison of double-flap and OrVil techniques of laparoscopy-assisted proximal gastrectomy in preventing gastroesophageal reflux: a retrospective cohort study. Langenbecks Arch Surg 404, 81–91 (2019). https://doi.org/10.1007/s00423-018-1743-5

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