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01-02-2019 | Laparoscopy | ORIGINAL ARTICLE

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

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

Published in: Langenbeck's Archives of Surgery | Issue 1/2019

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.

Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E359–E386. https://doi.org/10.1002/ijc.29210 CrossRefPubMed

Nashimoto A, Akazawa K, Isobe Y, Miyashiro I, Katai H, Kodera Y, Tsujitani S, Seto Y, Furukawa H, Oda I, Ono H, Tanabe S, Kaminishi M (2013) Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry. Gastric Cancer 16(1):1–27. https://doi.org/10.1007/s10120-012-0163-4 CrossRefPubMed

Hosoda K, Yamashita K, Katada N, Moriya H, Mieno H, Shibata T, Sakuramoto S, Kikuchi S, Watanabe M (2016) Potential benefits of laparoscopy-assisted proximal gastrectomy with esophagogastrostomy for cT1 upper-third gastric cancer. Surg Endosc 30(8):3426–3436. https://doi.org/10.1007/s00464-015-4625-8 CrossRefPubMed

Kosuga T, Ichikawa D, Komatsu S, Okamoto K, Konishi H, Shiozaki A, Fujiwara H, Otsuji E (2015) Feasibility and nutritional benefits of laparoscopic proximal gastrectomy for early Gastric Cancer in the upper stomach. Ann Surg Oncol 22(Suppl 3):S929–S935. https://doi.org/10.1245/s10434-015-4590-4 CrossRefPubMed

Zhao P, Xiao SM, Tang LC, Ding Z, Zhou X, Chen XD (2014) Proximal gastrectomy with jejunal interposition and TGRY anastomosis for proximal gastric cancer. World J Gastroenterol 20(25):8268–8273. https://doi.org/10.3748/wjg.v20.i25.8268 CrossRefPubMedPubMedCentral

Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, Yamaue H, Yoshikawa T, Kojima K (2010) Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13(4):238–244. https://doi.org/10.1007/s10120-010-0565-0 CrossRefPubMed

Katai H, Mizusawa J, Katayama H, Takagi M, Yoshikawa T, Fukagawa T, Terashima M, Misawa K, Teshima S, Koeda K, Nunobe S, Fukushima N, Yasuda T, Asao Y, Fujiwara Y, Sasako M (2017) Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan clinical oncology group study JCOG0912. Gastric Cancer 20(4):699–708. https://doi.org/10.1007/s10120-016-0646-9 CrossRefPubMed

Sakuramoto S, Yamashita K, Kikuchi S, Futawatari N, Katada N, Watanabe M, Okutomi T, Wang G, Bax L (2013) Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term clinical outcomes of a randomized clinical trial. Surg Endosc 27(5):1695–1705. https://doi.org/10.1007/s00464-012-2658-9 CrossRefPubMed

Hosoda K, Yamashita K, Moriya H, Mieno H, Ema A, Washio M, Watanabe M (2017) Laparoscopically assisted proximal gastrectomy with Esophagogastrostomy using a novel “open-door” technique : LAPG with novel reconstruction. J Gastrointest Surg 21(7):1174–1180. https://doi.org/10.1007/s11605-016-3341-6 CrossRefPubMed

10.

Kuroda S, Nishizaki M, Kikuchi S, Noma K, Tanabe S, Kagawa S, Shirakawa Y, Fujiwara T (2016) Double-flap technique as an Antireflux procedure in Esophagogastrostomy after proximal gastrectomy. J Am Coll Surg 223(2):e7–e13. https://doi.org/10.1016/j.jamcollsurg.2016.04.041 CrossRefPubMed

11.

Muraoka A, Kobayashi M, Kokudo Y (2016) Laparoscopy-assisted proximal gastrectomy with the hinged double flap method. World J Surg 40(10):2419–2424. https://doi.org/10.1007/s00268-016-3510-5 CrossRefPubMed

12.

Hayami M, Hiki N, Nunobe S, Mine S, Ohashi M, Kumagai K, Ida S, Watanabe M, Sano T, Yamaguchi T (2017) Clinical outcomes and evaluation of laparoscopic proximal gastrectomy with double-flap technique for early Gastric Cancer in the upper third of the stomach. Ann Surg Oncol 24(6):1635–1642. https://doi.org/10.1245/s10434-017-5782-x CrossRefPubMed

13.

Shibasaki S, Suda K, Nakauchi M, Kikuchi K, Kadoya S, Ishida Y, Inaba K, Uyama I (2017) Robotic valvuloplastic esophagogastrostomy using double flap technique following proximal gastrectomy: technical aspects and short-term outcomes. Surg Endosc 31(10):4283–4297. https://doi.org/10.1007/s00464-017-5489-x CrossRefPubMed

14.

Japanese Gastric Cancer A (1998) Japanese classification of Gastric carcinoma - 2nd English edition. Gastric Cancer 1(1):10–24. https://doi.org/10.1007/s101209800016 CrossRef

15.

Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14(2):113–123. https://doi.org/10.1007/s10120-011-0042-4 CrossRef

16.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral

17.

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2 CrossRefPubMed

18.

Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM (2011) Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc 25(3):855–860. https://doi.org/10.1007/s00464-010-1281-x CrossRefPubMed

19.

Lind T, Cederberg C, Ekenved G, Haglund U, Olbe L (1983) Effect of omeprazole--a gastric proton pump inhibitor--on pentagastrin stimulated acid secretion in man. Gut 24(4):270–276CrossRefPubMedPubMedCentral

20.

Jobe BA, Richter JE, Hoppo T, Peters JH, Bell R, Dengler WC, DeVault K, Fass R, Gyawali CP, Kahrilas PJ, Lacy BE, Pandolfino JE, Patti MG, Swanstrom LL, Kurian AA, Vela MF, Vaezi M, DeMeester TR (2013) Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the esophageal diagnostic advisory panel. J Am Coll Surg 217(4):586–597. https://doi.org/10.1016/j.jamcollsurg.2013.05.023 CrossRefPubMed

21.

Richter JE, Bradley LA, DeMeester TR, Wu WC (1992) Normal 24-hr ambulatory esophageal pH values. Dig Dis Sci 37(6):849–856CrossRefPubMed

22.

Shay S, Tutuian R, Sifrim D, Vela M, Wise J, Balaji N, Zhang X, Adhami T, Murray J, Peters J, Castell D (2004) Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol 99(6):1037–1043. https://doi.org/10.1111/j.1572-0241.2004.04172.x CrossRefPubMed

23.

Dimenas E, Glise H, Hallerback B, Hernqvist H, Svedlund J, Wiklund I (1993) Quality of life in patients with upper gastrointestinal symptoms. An improved evaluation of treatment regimens? Scand J Gastroenterol 28(8):681–687CrossRefPubMed

24.

Aihara R, Mochiki E, Ohno T, Yanai M, Toyomasu Y, Ogata K, Ando H, Asao T, Kuwano H (2010) Laparoscopy-assisted proximal gastrectomy with gastric tube reconstruction for early gastric cancer. Surg Endosc 24(9):2343–2348. https://doi.org/10.1007/s00464-010-0947-8 CrossRefPubMed

25.

Hiki N, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, Ohyama S, Seto Y, Muto T (2007) Laparoscopic esophagogastric circular stapled anastomosis: a modified technique to protect the esophagus. Gastric Cancer 10(3):181–186. https://doi.org/10.1007/s10120-007-0433-8 CrossRefPubMed

26.

Takeuchi H, Oyama T, Kamiya S, Nakamura R, Takahashi T, Wada N, Saikawa Y, Kitagawa Y (2011) Laparoscopy-assisted proximal gastrectomy with sentinel node mapping for early gastric cancer. World J Surg 35(11):2463–2471. https://doi.org/10.1007/s00268-011-1223-3 CrossRefPubMed

27.

Wang S, Lin S, Wang H, Yang J, Yu P, Zhao Q, Li M (2018) Reconstruction methods after radical proximal gastrectomy: a systematic review. Medicine (Baltimore) 97(11):e0121. https://doi.org/10.1097/md.0000000000010121 CrossRef

Title: Comparison of double-flap and OrVil techniques of laparoscopy-assisted proximal gastrectomy in preventing gastroesophageal reflux: a retrospective cohort study
Authors: Kei Hosoda
Marie Washio
Hiroaki Mieno
Hiromitsu Moriya
Akira Ema
Hideki Ushiku
Masahiko Watanabe
Keishi Yamashita
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Keywords: Laparoscopy
Gastrectomy
Gastric Cancer
Gastric Cancer
Gastrectomy
Published in: Langenbeck's Archives of Surgery / Issue 1/2019
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-018-1743-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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