Right-sided overlap and single-flap valvuloplasty following laparoscopic proximal gastrectomy reduces reflux and stenosis

In terms of avoiding reflux and stenosis and preserving nutritional status, right-sided overlap and single-flap valvuloplasty (ROSF) may be safely conducted following laparoscopic proximal gastrectomy (LPG), says an article published in BMC Surgery.

There is no established procedure for rebuilding after proximal gastrectomy, which raises serious concerns about anastomotic and gastroesophageal reflux problems. None of the methods-including the double tract reconstruction, double-flap approach, and side overlap fundoplication by Yamashita-are seen to be optimal ways to deal with these postoperative issues. Here, Wei Peng and company present the right-sided overlap and single-flap valvuloplasty, a new technique for esophagogastrostomy following laparoscopic proximal gastrectomy.

At the Second Affiliated Hospital of Soochow University's Department of Gastrointestinal Surgery, 20 consecutive patients received LPG-ROSF from March 2021 to December 2021. Postoperative problems and surgical results were noted. Up to December 2022, all patients were followed up with. One year following surgery, an endoscopy was done to evaluate digestive issues. One year following surgery, measurements of nutrition-related variables, such as total body weight, lymphocyte count, hemoglobin, serum total protein, serum albumin, and serum prealbumin, were made and the results were compared to the preoperative values.

The key findings of this study were:

1. The average lengths of the operation and anastomosis were 285.3 ± 71.3 and 61.3 ± 11.2 minutes, respectively.

2. There were no gastrointestinal early postoperative problems in any of the patients. One patient (5%) experienced symptomatic reflux, while another (5%) experienced reflux esophagitis (Los Angeles Grade A).

3. However, none of the four patients (20%) who had mild dysphagia (Visick score = II) also had anastomotic stenosis. The nutritional status did not significantly alter after surgery.

In this case-series investigation of the first 20 patients, ROSF showed positive outcomes in terms of reducing reflux and stenosis, enhancing feeding, streamlining manipulation, and speeding up surgery. Researchers think that their approach is a secure and effective choice for rebuilding after LPG. Its benefits still need to be confirmed in large-scale trials with extended follow-up.

Reference:

Peng, W., Yan, S., Huang, Y., Cheng, M., Liu, T., Ren, R., Chen, Q., Zhang, J., Gong, W., Xing, C., & Wu, Y. (2023). Laparoscopic proximal gastrectomy with right-sided overlap and single-flap valvuloplasty (ROSF): a case-series study. In BMC Surgery (Vol. 23, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12893-023-01975-y