Technique and Clinical Outcome of Laparoscopy proximal gastrectomy with partial fundoplication in early gastric cancer

Hirofumi Sugita, MD, Shinichi Sakuramoto, MD, Hiroki Takeshita, MD, Yohei Morita, MD, Katsuhiro Anami, MD, Shinichi Oka, MD, Hiroshi Satoh, MD, Isamu Koyama, MD. Department of Digestive Surgery, Saitama International Medical Center

Background

Reconstruction methods after Laparoscopic proximal gastrectomy (LPG) in early gastric cancer are various. We present the technique and clinical outcome of laparoscopy proximal gastrectomy with partial fundoplication.

Methods

A camera port is inserted into the upper umbilicus region and four operating ports are placed. Lymph node dissection are performed. The esophagus is dissected using a linear stapler following complete detachment of the paraesophageal region; this is followed by proximal gastrectomy with extraction of the stomach via the 4 cm mini-incision. Under laparoscopic view, an anastomosis of the esophagus and the anterior wall of remnant stomach is performed using the transoral OrVil and a circular stapler passed through a small opening of the anterior wall of remnant stomach. Finally, partial fundoplication is performed by looping the remnant stomach around the esophagus

Result

From January 2013 through September 2014, LPG was performed in 21 patients. The median operation time was 285 minutes, blood loss was 44ml, and the number of dissected lymph nodes was 25. Regarding postoperative complications, anastomotic leakage and stenosis occurred in each one patient. Two patients had reflex esophagitis, and PPI were effective in these patients.

Conclusion

Esogaphagogastrostomy with partial fundoplication cancer could be a safe and feasible reconstraction after LPG in patient with early gastric cancer.

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