Esophagogastrostomy using seromuscular double-flap technique following laparoscopy-assisted proximal gastrectomy: a case report of gastrointestinal stromal tumor at the gastric cardia and literature review

Abstract

Abstract:

ObjectiveTo investigate the clinical efficacy of esophagogastrostomy using seromuscular double-flap technique following laparoscopy-assisted proximal gastrectomy.MethodsThe clinical data of one patient with gastrointestinal stromal tumor at the gastric cardia who underwent laparoscopy-assisted proximal gastrectomy in September 2019 was retrospectively analyzed. We reviewed the literature about esophagogastrostomy using seromuscular double-flap technique following proximal gastrectomy and summarized the clinical data.ResultsThis case was a 67-year-old male patient. The patient was diagnosed as gastrointestinal stromal tumor at the gastric cardia by both preoperative imaging and postoperative pathologic examination. Laparoscopy-assisted proximal gastrectomy and esophagogastrostomy using seromuscular double-flap technique was performed. The total operative time and anastomosis time were 280 min and 100 min, respectively. The intraoperative blood loss was 40 mL. The time to the first postoperative flatus was 3 d. The time to the liquid diet was 4 d. The duration of postoperative hospital stay was 8 d. No postoperative short-term complication was found. No reflux esophagitis was shown two months postoperatively with endoscopy. The literature review showed that the occurrence of anastomotic leakage, anastomotic bleeding, anastomotic stenosis, and reflux esophagitis of esophagogastrostomy using seromuscular double-flap technique were 0-4.2%, 0-0.7%, 4.0%-29.1%, and 0-8.3%, respectively.ConclusionsEsophagogastrostomy using seromuscular double-flap technique following laparoscopy-assisted proximal gastrectomy was safe and effective in terms of preventing gastroesophageal reflux. It can be applied in highly selected patient with upper-third gastric tumor. High attention is still required to prevent and treat the postoperative anastomotic stenosis.

Key words:Seromuscular double-flap technique,Esophagogastrostomy,Laparoscopic proximal gastrectomy,Reflux esophagitis,Gastrointestinal stromal tumor

CLC Number:

R735.2

YAN Chao, LU Sheng, HE Xiangyi, FENG Runhua, LI Chen, YAN Min, ZHU Zhenggang. Esophagogastrostomy using seromuscular double-flap technique following laparoscopy-assisted proximal gastrectomy: a case report of gastrointestinal stromal tumor at the gastric cardia and literature review[J]. Journal of Surgery Concepts & Practice, 2020, 25(01): 50-55.

Figures/Tables7

作者	发表年份	n	手术时间 (min)	吻合时间 (min)	出血量 (mL)	保留迷走神经	幽门成形术	吻合方法 (%)	吻合口漏	吻合口出血	吻合口狭窄	反流性食管炎
Muraoka等^{[ 1 ]}	2016年	24	372	-	108	保留肝支和腹腔支	否	LR	4.2%	0	29.1%	5.0%
Kuroda等^{[ 8 ]}	2016年	33	MLR(288)/LR(342)	MLR(84)/LR(114)	-	-	-	MLR(60.6)/LR(39.4)	0	0	MLR(5.0%)/LR(15.4%)	0
Nunobe等^{[ 5 ]}	2017年	50	389	-	89	保留肝支,尽可能保留腹腔支	-	LR	0	0	4.0%	2.0%
Hosoda等^{[ 9 ]}	2017年	20	333	81	100	-	否	LR	0	0	10.0%	0
Shibasaki等^{[ 4 ]}	2017年	12	406	104	31	保留肝支,不常规保留腹腔支	否	RR	0	0	25.0%	8.3%
Hayami等^{[ 10 ]}	2017年	43	387	-	75	保留肝支,尽可能保留腹腔支	-	LR	0	0	4.7%	2.3%
Hosoda等^{[ 7 ]}	2019年	40	353	-	65	-	否	LR	0	0	17.5%	8.3%
Shoji等^{[ 6 ]}	2019年	147	420	-	-	保留肝支,尽可能保留腹腔支	-	LR	3.4%	0.7%	8.3%	4.2%
Kuroda等^{[ 2 ]}	2019年	546	298	-	240	保留肝支(70.1%), 保留腹腔支(46.3%)	-	OR(57.0)/MLR(23.1)/LR(14.8)/ 其他（5.1）	1.5%	0.6%	5.5%	6.0%

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