title: Novel fundoplication for esophagogastrostomy after proximal gastrectomy.
abstract: OBJECTIVE
  Stapled esophagogastrostomy is simple and safe reconstruction after proximal gastrectomy. However, this reconstruction is often concomitant with severe reflux esophagitis because of the loss of cardiac function; simple esophagogastrostomy is not preferred reconstruction after proximal gastrectomy. To prevent reflux esophagitis, we established the fundoplication under the endoscopic stent after proximal gastrectomy.
  
  
  METHODS
  After proximal gastrectomy with lymph node dissection, end-to-side esophago-gastrostomy was done with circular suturing instrument. To prevent gastric juice reflux from the remnant stomach, the stomach was rolling around the abdominal esophagus and tightly under the endoscopical stenting. To make renewal His angle and fornix, the stump of greater curvature was fixed to the left side of diaphragmatic crus with some sutures.
  
  
  RESULTS
  We performed this type of fudplication for 18 patients with early gastric cancers and gastric submucosal tumors. Almost all patients postoperative course was uneventful. Three patients needed an endoscopic dilatation for the stricture of esophago-gastrostomy. One case revealed asymptomatic reflux esophagitis because of the looseness of the anastomosis. Weight loss was limited, almost all patients recovered preoperative weight.
  
  
  CONCLUSIONS
  Simple esophagogastrostomy plus this fundoplication with endoscopic stent is safe and satisfactory reconstruction procedure after proximal gastrectomy.
authors.forename: Sumiya
authors.initials: S
authors.lastname: Ishigami
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Uenosono
authors.forename: Takaaki
authors.initials: T
authors.lastname: Arigami
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kurahara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okumura
authors.forename: Masataka
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kijima
authors.forename: Shegehiro
authors.initials: S
authors.lastname: Yanagita
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nakajo
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Mori
authors.forename: Kosei
authors.initials: K
authors.lastname: Maemura
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ueno
authors.forename: Shoji
authors.initials: S
authors.lastname: Natsugoe
mesh_terms: D000368:Aged; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation; D004942:Esophagitis, Peptic / Q000209:etiology / Q000517:prevention & control; D004946:Esophagostomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005743:Gastrectomy; D018530:Gastric Stump / Q000601:surgery*; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008197:Lymph Node Excision; D008297:Male; D015607:Stents; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome