[Analysis of short-term efficacy of modified double muscle flap anastomosis based on double barbed sutures (DDBS) in 112 cases of proximal gastrectomy].

Objective: To investigate the short-term efficacy of modified double muscle flap anastomosis with double barbed sutures (DDBS). Methods: A retrospective observational study was conducted. Clinical data of 112 patients with esophagogastric junction cancer or upper gastric cancer who underwent proximal gastrectomy combined with DDBS anastomosis at Changzhi People's Hospital Affiliated to Changzhi Medical College from November 2019 to September 2024 were collected. The cohort included 89 males and 23 females, with a mean age of (64.9±7.4) years. Surgical approaches consisted of 109 laparoscopic surgeries and 3 open surgeries. The main steps of DDBS anastomosis were as follows: (1) A "I"-shaped area measuring approximately 2.5 cm × 3.5 cm was marked on the anterior wall of the residual stomach, 1.5 cm from the stump. The seromuscular layer of the gastric wall was incised and dissected to create muscle flaps; (2) After muscle flap creation, the submucosal and mucosal layers were incised 0.5 cm above the lower edge of the muscle flap window to form the upper and lower lips of the residual gastric opening; (3) The residual stomach was returned to the abdominal cavity, and the posterior wall of the esophagus was marked with methylene blue 5 cm from the esophageal stump; (4) Barbed sutures were used for continuous suturing of 4 stitches to fix the residual stomach to the posterior esophageal wall; (5) The esophageal stump was opened using an ultrasonic scalpel; (6) The first barbed suture was used to continuously suture the full-thickness posterior wall of the esophageal stump to the upper lip of the residual gastric opening from left to right, exiting through the gastric serosa on the right side for later use; (7) The second barbed suture was used to continuously suture the full-thickness anterior wall of the esophageal stump to the lower lip of the residual gastric opening from right to left, exiting through the gastric serosa on the left side for later use; (8) The reserved barbed sutures on both sides were used to continuously suture the lower edge of the muscle flaps to the gastric wall, and then upward to suture the muscle flaps to the esophageal wall after meeting at the junction of the two muscle flaps; (9) A "Y"-shaped collar-like structure was finally formed. Surgery-related indicators and postoperative follow-up data of DDBS anastomosis were collected and analyzed. The incidence and severity of reflux esophagitis and its anti-reflux efficacy were evaluated based on postoperative endoscopic examinations, GerdQ scores, and multi-position upper gastrointestinal contrast imaging. Postoperative Visick classification, body mass index (BMI), albumin, total protein, and hemoglobin levels were also followed up to assess postoperative quality of life and nutritional status. Results: All 112 patients successfully underwent proximal gastrectomy plus DDBS anastomosis, achieving R0 resection. Intraoperative rapid frozen pathological examination of the surgical margins was negative in all cases, with no perioperative mortality. The median operative time was 205 (190, 224) minutes, the digestive tract reconstruction time was (53.4±5.9) minutes, the median intraoperative blood loss was 50 (40, 60) ml, and the number of lymph nodes dissected was (29.3±12.5). No unplanned readmissions occurred. A total of 6 cases (5.4%) had perioperative complications, including 1 case of anastomotic leakage complicated with pleural effusion and 5 cases of simple pleural effusion, all classified as Clavien-Dindo grade IIIa. No pancreatic fistula, anastomotic bleeding, or perioperative mortality occurred. Postoperatively, 10 patients developed anastomotic stenosis, including 8 cases of Clavien-Dindo grade IIIa and 2 cases of Clavien-Dindo grade I. The median time to oral intake was 3 (3, 4) days, and the median postoperative hospital stay was 9 (8, 12) days. With a median follow-up of 24 (6-36) months, no tumor recurrence or cancer-related deaths were observed. Reflux esophagitis was endoscopically detected in 4 patients; among them, 2 patients had a GerdQ score >8 points, and 2 patients showed reflux on multi-position gastrointestinal contrast imaging. Quality of life assessment revealed 102 cases with Visick grade I, 8 cases with grade II, and 2 cases with grade III, with no grade IV cases. Conclusion: DDBS anastomosis is safe and feasible, with definite anti-reflux efficacy. Patients achieve favorable postoperative quality of life and nutritional status.