Pure single-port laparoscopic proximal gastrectomy using a novel double-flap technique

Abstract

We developed a novel double-flap technique as an anti-reflux procedure following sin-gle-port laparoscopic proximal gastrectomy. After performing laparoscopic proximal gas-trectomy, an H-shaped seromuscular flap is created on the anterior wall of the gastric remnant and then reconstruction procedure is started. First, the posterior esophageal wall is fixed to the stomach at the cranial edge of the submucosal window. Second, the posterior wall of the esophagus and the gastric mucosa are sutured and layer-to-layer suturing is then performed between the anterior esophagus and stomach to complete the esophagogas-trostomy. Finally, the anastomotic site and distal esophagus are covered with the sero-muscular flap. All steps were performed using continuous barbed sutures to facilitate anastomotic procedures. The above mentioned procedure is safe and feasible for the treatment of gastric cancer with acceptable short- and mid-term results. Thus, this pro-cedure may be an attractive surgical option as a minimally invasive surgery.