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A Spade shaped Anastomosis Following Proximal Gastrectomy using Double suture fixing Posterior wall of Esophagus to Anterior wall of the stomach (SPADE operation)

Wonho Han, Bang Wool Eom, Hong Man Yoon, Junsun Ryu, Young-Woo Kim. National Cancer Center

Objective: Aim of this study was to show early clinical outcome compared with previous proximal gastrectomy (PG) cases.

Background: PG has been performed as function-preserving surgery in proximally located early gastric cancer. As gastroesophageal reflux is a major pitfall of this operation, we devised a modified esophagogastrostomy (EG) anastomosis to fix the distal part of the posterior esophageal wall and the proximal part of the anterior stomach wall to produce an anti-reflux mechanism and named it as SPADE operation.

Methods: A total of 56 patients who underwent PG from January 2012 to March 2018 were retrospectively reviewed. Thirty patients underwent conventional esophagogastrostomy (CEG) anastomosis using circular stapler. Twenty-six patients underwent the SPADE operation. Early postoperative clinical outcomes related reflux symptoms, endoscopic findings and postoperative complications were compared as a case–control study.

Results: Follow-up endoscopy showed more frequent reflux esophagitis in the CEG group than in the SPADE group (30% vs 15.3% p = 0.19). Bile reflux was higher in the CEG group (26.7% vs 7.7% p = 0.08) and residual food was also higher in the CEG group in endoscopic finding with statistical significance (p = 0.01).

In the CEG group, 13 patients (43.3%) had mild reflux symptoms, while three patients had severe symptoms. In the SPADE group, three patients had mild reflux symptoms (11.5%), while one had severe symptoms without statistical significance (absolute difference 31.8%, 95% Cl 1.11 – 29.64, p= 0.01).

Conclusion: A novel modified EG called SPADE operation showed potential in reducing gastroesophageal reflux in PG.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94954

Program Number: P500

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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