title: Side overlap esophagogastrostomy to prevent reflux after proximal gastrectomy.
abstract: BACKGROUND
  No optimal method of reconstruction for proximal gastrectomy has been established because of problems associated with postoperative reflux and anastomotic stenosis. It is also important that the reconstruction is easily performed laparoscopically because laparoscopic gastrectomy has become widely accepted in recent years.
  
  
  METHODS
  We have developed a new method of esophagogastrostomy, side overlap with fundoplication by Yamashita (SOFY). The remnant stomach is fixated to the diaphragmatic crus on the dorsal side of the esophagus. The esophagus and the remnant stomach are overlapped by a length of 5 cm. A linear stapler is inserted in two holes on the left side of the esophageal stump and the anterior gastric wall. The stapler is rotated counterclockwise on its axis and fired. The entry hole is closed, and the right side of the esophagus is fixated to the stomach so that the esophagus sticks flat to the gastric wall. The surgical outcomes of the SOFY method were compared with those of esophagogastrectomy different from SOFY.
  
  
  RESULTS
  Thirteen of the 14 patients in the SOFY group were asymptomatic without a proton pump inhibitor, but reflux esophagitis was observed in 5 of the 16 patients in the non-SOFY group and anastomotic stenosis was observed in 3 patients. Contrast enhancement findings in the SOFY group showed inflow of Gastrografin to the remnant stomach was extremely good, and no reflux into the esophagus was observed even with patients in the head-down tilt position.
  
  
  CONCLUSIONS
  SOFY can be easily performed laparoscopically and may overcome the problems of postoperative reflux and stenosis.
authors.affiliation: Department of Gastroenterological Surgery, Japanese Red Cross Society Wakayama Medical Center, 4-20 Komatsubaradori, Wakayama, 640-8558, Japan. helji3852@yahoo.co.jp.|Department of Gastroenterological Surgery, Osaka City General Hospital, 4-20 Komatsubaradori, Wakayama, 640-8558, Japan. helji3852@yahoo.co.jp.
authors.forename: Yoshito
authors.identifier: http://orcid.org/0000-0002-5291-0765
authors.initials: Y
authors.lastname: Yamashita
authors.affiliation: Department of Surgery, Sumitomo Hospital, 4-20 Komatsubaradori, Wakayama, 640-8558, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamamoto
authors.affiliation: Department of Gastroenterological Surgery, Osaka City General Hospital, 4-20 Komatsubaradori, Wakayama, 640-8558, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tamamori
authors.affiliation: Department of Surgery, Sumitomo Hospital, 4-20 Komatsubaradori, Wakayama, 640-8558, Japan.
authors.forename: Mami
authors.initials: M
authors.lastname: Yoshii
authors.affiliation: Department of Gastroenterological Surgery, Osaka City General Hospital, 4-20 Komatsubaradori, Wakayama, 640-8558, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Nishiguchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000517:prevention & control*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Esophagogastrostomy; Laparoscopic gastrectomy; Proximal gastrectomy