Comparison of double-flap and OrVil techniques of laparoscopy-assisted proximal gastrectomy in preventing gastroesophageal reflux: a retrospective cohort study.
BACKGROUND
Laparoscopy-assisted proximal gastrectomy (LAPG) with esophagogastrostomy using the double-flap technique has been reported to rarely cause gastroesophageal reflux. However, quantitative evaluation of the reflux has hardly been performed. The aim of this study was to clarify the superiority of the double-flap technique of LAPG with esophagogastrostomy compared with the OrVil technique in terms of preventing gastroesophageal reflux.


METHODS
A total of 40 and 51 patients who underwent LAPG with esophagogastrostomy using the double-flap and OrVil techniques, respectively, for upper one-third gastric cancer were included in this study. Of these, 22 and 13 patients in the double-flap and OrVil groups, respectively, consented to undergo a 24-h impedance-pH monitoring test at 3 months postoperatively. Postoperative complications, including gastroesophageal reflux and anastomotic stricture, were assessed retrospectively.


RESULTS
No significant differences were observed in the patients' background between both groups, except for a higher D1+ dissection rate observed in double-flap group than in the OrVil group (93% vs 25%, P < 0.001). Operative time was significantly longer in the double-flap group than in the OrVil group (353 min vs 280 min, P < 0.001). All reflux % time was significantly lower in the double-flap group than in the OrVil group (1.29% vs 2.62%, P = 0.043). On the other hand, the proportion of anastomotic stricture requiring endoscopic balloon dilatation was lower in the double-flap group than in the OrVil group but without statistical significance (18% vs 27%; P = 0.32).


CONCLUSIONS
Despite its longer operative time and still relatively high anastomotic stricture rate, the double-flap technique would be better than the OrVil technique in terms of preventing gastroesophageal reflux in patients who underwent LAPG with esophagogastrostomy.
['Hosoda|Kei|K|http://orcid.org/0000-0002-9787-2889', 'Washio|Marie|M|', 'Mieno|Hiroaki|H|', 'Moriya|Hiromitsu|H|', 'Ema|Akira|A|', 'Ushiku|Hideki|H|', 'Watanabe|Masahiko|M|', 'Yamashita|Keishi|K|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D004946:Esophagostomy D005260:Female D005743:Gastrectomy D005764:Gastroesophageal Reflux D005774:Gastrostomy D006801:Humans D010535:Laparoscopy D008297:Male D008875:Middle Aged D061646:Operative Time D011183:Postoperative Complications D012189:Retrospective Studies D013274:Stomach Neoplasms D013524:Surgical Flaps
Proximal gastrectomy Gastroesophageal reflux Esophagogastrostomy Anastomotic stricture Laparoscopic surgery