title: Double-tract reconstruction after laparoscopic proximal gastrectomy using detachable ENDO-PSD.
abstract: Proximal gastrectomy (PG) is widely performed in Japan as a function-preserving surgical approach. Since esophagogastrostomy (EG) was associated with increased reflux symptoms and anastomotic strictures, we have chosen double-tract reconstruction (DTR) as the standard reconstruction method since March 2013. In this study, we described a novel method of laparoscopic DTR using detachable ENDO-PSD and compared its 1-year outcome with EG performed formerly in our institution.
  
  
  
  Patients who underwent laparoscopic PG between May 2005 and July 2014 were retrospectively divided into two groups based on the type of reconstruction and were subsequently analyzed (19 patients in the DTR group and 22 in the EG group). All of them underwent a laparoscopic PG with regional lymph node dissection. In the DTR group, the lower left port site was extended to 4 cm, and an intracorporeal purse-string suture was performed using the detachable ENDO-PSD. The jejunogastrostomy was fashioned on the anterior side of the remnant stomach parallel to the transection line, 2 cm from the cut end. The EG group used the conventional purse-string suture instrument through the 6 cm upper midline mini-laparotomy incision. Patient characteristics, operative data, early operative complications and 1-year postoperative follow-up findings were compared between the two groups.
  
  
  
  The frequencies of reflux symptoms (10.5 vs. 54.5%, P = 0.003), usage of proton pump inhibitors (31.6 vs. 72.7%, P = 0.008), and anastomotic strictures (0 vs. 27%, P = 0.014) were significantly lower in the DTR group as compared to the EG group. There were no significant differences between the two groups with regard to operation time, blood loss, postoperative hospital stay, postoperative complications, average postoperative/preoperative weight loss ratio, and postoperative/preoperative ratio of biochemical markers (hemoglobin, total protein, albumin, cholesterol).
  
  
  
  Our results indicate that DTR is a useful reconstruction method after PG, especially in terms of preventing reflux esophagitis and anastomotic strictures.
authors.affiliation: Department of Gastric Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan. abrsrg2@tmd.ac.jp.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Aburatani
authors.affiliation: Department of Gastric Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan. k-kojima.srg2@tmd.ac.jp.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Kojima
authors.affiliation: Department of Gastric Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Otsuki
authors.affiliation: Department of Gastric Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Murase
authors.affiliation: Department of Gastric Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Okuno
authors.affiliation: Department of Gastric Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Gokita
authors.affiliation: Department of Gastric Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan.
authors.forename: Chiharu
authors.initials: C
authors.lastname: Tomii
authors.affiliation: Department of Gastric Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Tanioka
authors.affiliation: Department of Gastric Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan.
authors.forename: Mikito
authors.initials: M
authors.lastname: Inokuchi
mesh_terms: D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D007564:Japan; D010535:Laparoscopy / Q000379:methods; D008297:Male; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Double-tract reconstruction; ENDO-PSD; Gastric cancer; Laparoscopic proximal gastrectomy; Laparoscopy; Proximal gastrectomy