title: Surgical techniques to prevent reflux esophagitis in proximal gastrectomy reconstructed by esophagogastrostomy with preservation of the lower esophageal sphincter, pyloric and celiac branches of the vagal nerve, and reconstruction of the new His angle for early proximal gastric cancer.
abstract: OBJECTIVE
  This article describes the surgical techniques to prevent reflux esophagitis (RE) after proximal gastrectomy reconstructed by esophagogastrostomy (PGE) preservation of the lower esophageal sphincter (LES) and both pyloric and celiac branches of the vagal nerve (PCVN), and reconstruction of the new His angle (HA) for early proximal gastric cancer (PGC).
  
  
  METHODS
  Twenty patients after PGE were divided into 2 groups (group A: 10 patients without preserved LES and PCVN for advanced PGC; group B: 10 patients with preserved LES and PCNV and the addition of a new HA for early PGC). A postoperative interview on gastroesophageal reflux disease (GERD) and satisfaction with this procedure and the collection of endoscopic findings for RE and stasis of the remnant stomach (SRS) were conducted 1 year after PGE in groups A and B.
  
  
  RESULTS
  The rates of proton pump inhibitor administration and the symptoms of GERD, RE and SRS in group A were significantly higher than those in group B (p = 0.0433, p = 0.0190, p = 0.0253, p = 0.0190, respectively). Seven out of 10 patients in group A voiced dissatisfaction. Patients in group B were significantly more satisfied with this procedure than those in group A (p = 0.0010).
  
  
  CONCLUSIONS
  This method is useful for preventing postoperative GERD including RE in early PGC patients.
authors.affiliation: Department of Surgery, Nippon Dental University School of Life Dentistry, 2-3-16 Fujimi, Chiyoda-ku, Tokyo, 102-8158, Japan. rtomita@tky.ndu.ac.jp.|First Department of Surgery, Nihon University School of Medicine, 30-1 Oyaguchi, Kamimachi, Itabashi-ku, Tokyo, 173-0032, Japan. rtomita@tky.ndu.ac.jp.
authors.forename: Ryouichi
authors.initials: R
authors.lastname: Tomita
mesh_terms: D000368:Aged; D002445:Celiac Artery / Q000294:innervation*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000517:prevention & control*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D011708:Pylorus / Q000294:innervation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013274:Stomach Neoplasms / Q000601:surgery*; D014630:Vagus Nerve / Q000601:surgery*
keywords: His angle; Lower esophageal sphincter; Proximal gastrectomy reconstructed by esophagogastrostomy; Pyloric and celiac branches of the vagal nerve; Reflex esophagitis