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<p>Anti-reflux reconstructions like the double-flap technique (DFT) after laparoscopic proximal gastrectomy (LPG) can be technically demanding. The tunnel-based flap concept offers a potential simplification. This study aimed to evaluate our experience with the tunnel-like flap (TLF) technique by directly comparing its operative efficiency and early outcomes with the established DFT. This retrospective study included 45 consecutive PGC patients undergoing LPG from January 2022 to December 2023. Twenty patients received TLF reconstruction (from 2023) and were compared with 25 patients who underwent DFT. The TLF technique involves creating a 3.0 × 2.8&#xa0;cm seromuscular flap on the remnant stomach, through which the esophagus is tunneled for anastomosis, with the flap then enveloping the esophagogastric junction. We compared patient characteristics, surgical outcomes, postoperative complications, and 12-month endoscopic findings. Baseline characteristics were comparable. The TLF group demonstrated significantly shorter mean operation time (206 ± 18&#xa0;min vs. 221 ± 17&#xa0;min, <i>P</i> = 0.0064) and anastomosis time (62 ± 8&#xa0;min vs. 75 ± 6&#xa0;min, <i>P</i> &lt; 0.001) compared to the DFT group. Harvested lymph nodes were similar (31 ± 11 vs. 33 ± 10, <i>P</i> = 0.527). No anastomotic leakage occurred in either group. Rates of other early complications were low and comparable. At 12&#xa0;months, incidence of reflux esophagitis (TLF: 5% vs. DFT: 8%, <i>P</i> = 0.589) and anastomotic stenosis (TLF: 5% vs. DFT: 8%, <i>P</i> = 0.589) were similar. The TLF technique is a safe reconstruction method with early outcomes comparable to DFT. Critically, it offers a significant advantage in improved operative efficiency, making it a compelling alternative to the more complex double-flap technique.</p>

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The tunnel-like flap technique for esophagogastrostomy in laparoscopic proximal gastrectomy: a comparative study on operative efficiency and early outcomes

  • 期刊论文

  • 发表日期：

    2026年4月3日

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  • Shun Zhang,
  • Ren-hao Hu,
  • Xi-mao Cui,
  • Xiao-hua Jiang

摘要

Anti-reflux reconstructions like the double-flap technique (DFT) after laparoscopic proximal gastrectomy (LPG) can be technically demanding. The tunnel-based flap concept offers a potential simplification. This study aimed to evaluate our experience with the tunnel-like flap (TLF) technique by directly comparing its operative efficiency and early outcomes with the established DFT. This retrospective study included 45 consecutive PGC patients undergoing LPG from January 2022 to December 2023. Twenty patients received TLF reconstruction (from 2023) and were compared with 25 patients who underwent DFT. The TLF technique involves creating a 3.0 × 2.8 cm seromuscular flap on the remnant stomach, through which the esophagus is tunneled for anastomosis, with the flap then enveloping the esophagogastric junction. We compared patient characteristics, surgical outcomes, postoperative complications, and 12-month endoscopic findings. Baseline characteristics were comparable. The TLF group demonstrated significantly shorter mean operation time (206 ± 18 min vs. 221 ± 17 min, P = 0.0064) and anastomosis time (62 ± 8 min vs. 75 ± 6 min, P < 0.001) compared to the DFT group. Harvested lymph nodes were similar (31 ± 11 vs. 33 ± 10, P = 0.527). No anastomotic leakage occurred in either group. Rates of other early complications were low and comparable. At 12 months, incidence of reflux esophagitis (TLF: 5% vs. DFT: 8%, P = 0.589) and anastomotic stenosis (TLF: 5% vs. DFT: 8%, P = 0.589) were similar. The TLF technique is a safe reconstruction method with early outcomes comparable to DFT. Critically, it offers a significant advantage in improved operative efficiency, making it a compelling alternative to the more complex double-flap technique.