Semi-embedded Valve Anastomosis: A new anti-reflux anastomotic method after proximal gastrectomy for adenocarcinoma of the oesophagogastric junction

Abstract Background: There is a high probability of gastroesophageal reflux after laparoscopic proximal gastrectomy for adenocarcinoma of the oesophagogastric junction (AEG). Various anti-reflux anastomotic methods are emerging in clinical practice; however, none of them have been widely accepted. We have innovated a new type of anti-reflux anastomotic method, named semi-embedded valve anastomosis. The aim of this study was to explore the feasibility and anti-reflux effect of the new anastomotic method.Methods: The clinical data of 28 patients with Siewert II AEG who were treated by semi-embedded valve anastomosis were collected. The key point of the operation is to reconstruct a simulated valve and form an anti-reflux barrier similar to the physiological mechanism. The gastroesophageal reflux disease questionnaire (GerdQ) and classification of gastroesophageal reflux under electron microscopy were used to evaluate gastroesophageal reflux after the operation.Results: The mean operative duration was 164.3±19.0 min, the median intraoperative haemorrhage volume was 65 ml, the average number of lymph nodes dissected was 23±2.6, the time for valve construction was 15.8±3.2 min, the time for anastomotic reconstruction was 35.4±4.8 min, the median time to first flatus was 3 d, and the median hospitalization duration was 12 d. There was one case of postoperative anastomotic stenosis. The GerdQ score [median (range)] was as follows: 2 (0-6), preoperation; 0 (0-8), 1 month postoperation; 2 (0-12), 3 months postoperation; and 3 (0-12), 6 months postoperation. The Wilcoxon signed-rank sum test was carried out at different times after the operation and the day before the operation, and the differences were not significant (P<0.05). There was one case of grade B gastroesophageal reflux according to the Los Angeles classification system among the gastrofibroscopic re-examination reports of 28 cases.Conclusion: Semi-embedded valve anastomosis is safe and feasible after proximal gastrectomy for Siewert II AEG and has good anti-reflux effects.