title: A newly modified esophagogastrostomy with a reliable angle of His by placing a gastric tube in the lower mediastinum in laparoscopy-assisted proximal gastrectomy.
abstract: BACKGROUND
  An optimal reconstruction method for proximal gastrectomy (PG) remains elusive. Esophagogastrostomy (EG) is technically simple but suffers from the disadvantage of gastroesophageal reflux. Jejunal interposition (JI) has a low rate of gastroesophageal reflux, but the procedure is more complicated, and delayed gastric emptying is a problem.
  
  
  METHODS
  We created a modified EG and have used the modified technique for PG since 2006. The procedure involves shaping the remnant stomach into a gastric conduit. The EG is performed high on the anterior wall, and the conduit is kept straight by applying a circular stapler inserted from the anterior wall of the antrum. The tip of the gastric conduit is then inserted into the lower mediastinum, creating a sharp angle of His. In this retrospective cohort study, the clinical and physiological outcomes were compared between 25 patients who underwent this procedure and 21 patients who underwent JI from 2001 to 2005.
  
  
  RESULTS
  Laparoscopic procedures were performed more frequently, and residual food and bile reflux were less common in the EG group than in the JI group. No significant differences in remnant gastritis or reflux esophagitis were observed between the two groups. However, the late complication of intestinal obstruction occurred only in the JI group.
  
  
  CONCLUSIONS
  The modified EG technique has advantages over the JI technique because of its simplicity and low incidence of residual food and bile reflux. The next step would be to explore this technique further by a prospective multi-institutional study to confirm the reproducibility of its benefits. Miniabstract: The modified EG technique has advantages over the JI technique because of its simplicity, high rate of laparoscopy use, and low incidence of gastroesophageal reflux.
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan. a-yasuda@surg.med.kindai.ac.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yasuda
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
authors.forename: Takushi
authors.initials: T
authors.lastname: Yasuda
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Imamoto
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kato
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Nishiki
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Iwama
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Makino
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Shiraishi
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shinkai
authors.affiliation: Cancer Center, Kinki University Hospital, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Imano
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Furukawa
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
authors.forename: Kiyokata
authors.initials: K
authors.lastname: Okuno
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Shiozaki
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D004945:Esophagoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013274:Stomach Neoplasms / Q000601:surgery*
keywords: Esophagogastrostomy; Gastric tube; Proximal gastrectomy