Clinical Experience of Laparoscopy-Assisted Proximal Gastrectomy with Toupet-Like Partial Fundoplication in Early Gastric Cancer for Preventing Reflux Esophagitis

BACKGROUND: Laparoscopy-assisted proximal gastrectomy (LAPG) has become prevalent for early gastric cancer in the upper stomach, but standard esophagogastrostomy is sometimes complicated with reflux esophagitis. Clinical outcomes are described here in patients with reconstruction by esophagogastrostomy with Toupet-like partial fundoplication (TPF) in LAPG. STUDY DESIGN: From November 2005 through December 2008, LAPG was performed in 36 patients with early gastric cancer, 26 (72.2%) of whom could have reconstruction with the TPF because the remnant stomach was sufficiently large. RESULTS: In LAPG with TPF, mean operation time was 293 minutes, mean blood loss was 119 g, and the mean number of dissected lymph nodes was 25.1. Regarding postoperative complications, anastomotic leakage occurred in two patients. More than I year after operation, 3 (15.0%) of the 20 patients had heartburn and 6 (30.0%) had reflux esophagitis (Los Angeles classification grade A, n = 2; grade B, n = 4); proton pump inhibitors were effective in these patients. CONCLUSIONS: Esophagogastrostomy with TPF could be a simple, safe, and useful technique for reconstruction after LAPG in patients with early gastric cancer, and its clinical usefulness is worthwhile for the prospective validation. (J Am Coll Surg 2009;209:344-351. (C) 2009 by the American College of Surgeons)