Analysis of the effect of modified muscle flap anastomosis after proximal gastrectomy
YUE Chao
PENG Rui
SUN Guangli
CHEN Liang
WANG Haitian
XU Weiguo
WEI Wei
ZHOU Bin
WEN Xu
GU Rongmin
MING Xuezhi
CHEN Huanqiu
LI Gang
Abstract：Objective To analyze the feasibility and efficacy of using esophagogastrostric modified muscular flap anastomosis plus gastric interposition operation in proximal gastrectomy.Methods A restrospective analysis was used to collect clinical data of 9 patients admitted to the Department of Gastric Surgery of Jiangsu Cancer Hospital from November 2019 to October 2022,and esophagogastrostric modified muscular flap anastomosis plus double-channel gastric interposition of the digestive tract reconstruction were performed after proximal gastrectomy Brief steps were to make a rectangular seromuscular flap(3.0 cmx3.5 cm).in the anterior wall of the remnant stomach,fixed at about 5.0 cm above the upper edge of the esophageal stump with the upper edge of muscular flap,the esophageal stump was inserted into the tunnel,the esophageal stump and the residual stomach were manually sutured,and the gastrojejunal anastomosis and jejunovjejunostomy were performed after the tunnel anastomosis was completed.The safety of surgery and the occurrence of postoperative complications were observed,and all patients were enrolled and completed endoscopic follow-up within 1 year,and the EORTC QLQ-C30 scale was used to evaluate quality of life one year after surgery.Results All cases were completed successfluly,including 2 cases of laparoscopic assisted surgeries and 7 cases of open surgeries.The operation time was(195.2±39.8)min,the anastomosis time was(69.8±4.1)min,the modified muscular flap preparation duration was(21.2±3.8)min,and intraoperative blood loss was(82.2±47.9)mL.The total hospital stay was(13.6±1.3)d.No postoperative complication above Clavien-Dindo grade Ⅱ occurred within 1 year.One year after surgery,all cases underwent endoscopic follow-up and no anastomotic stenosis or reflux esophagitis were detected.The scores of the health status and function scale were higher than those before operation(P＜0.05).and there was no significant difference in the scores of symptom scale(P=0.847).Conclusions Esophagogastrostric modified muscular flap anastomosis is a safe and feasible approach for proximal gastrectomy,and the seromuscular flap has good blood supply and maintains good one-way valve function,which may have potential effectiveness in reducing the incidence of reflux esophagitis and improving the quality of life.
Keywords：Proximal gastrectomyEsophagogastrostomyModified muscular flapDouble-channel gastric interposition reconstruction
Publication Date：2024-10-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 439-444 )