Dual-suture fundoplication for anti-reflux reconstruction after proximal gastrectomy: a single-center retrospective case series.

BACKGROUND

Esophagogastrostomy (EG) after proximal gastrectomy (PG) is widely used but often complicated by reflux. Current anti-reflux procedures, such as double-tract and double-flap reconstructions, are effective but technically demanding. We developed a simplified, device-free anti-reflux EG that uses two sutures to approximate the angle of His, the gastric angle, and a neofundus-like contour.

METHODS

We retrospectively analyzed 11 consecutive patients with upper-third gastric cancer who underwent laparoscopic PG followed by dual-suture fundoplication between May 2023 and November 2024. Surgical and clinical outcomes included operative time, blood loss, hospital stay, complications (Clavien-Dindo), reflux symptoms, endoscopic findings, and quality of life assessed using the Reflux Disease Questionnaire (RDQ) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). Continuous variables were summarized as mean ± standard deviation and range. Changes in RDQ and WHOQOL-BREF scores were compared using paired tests (paired t-test or Wilcoxon signed-rank test after normality assessment), with two-sided α = 0.05.

RESULTS

All procedures were successfully completed without intraoperative or postoperative complications (Clavien-Dindo). The mean operative time was 189.9 min and the mean hospital stay was 7.4 days. During a median follow-up of 12 months, no patient required proton pump inhibitors, and no reflux esophagitis of Los Angeles grade B or higher was observed. RDQ scores remained stable, while WHOQOL-BREF scores were higher in the social and environmental domains, suggesting favorable postoperative function and quality of life.

CONCLUSION

This simplified dual-suture esophagogastrostomy appeared safe and feasible in this cohort and demonstrated reassuring early postoperative outcomes with respect to reflux. Its minimal technical demands and favorable postoperative recovery profile suggest potential suitability for broader clinical application, although larger comparative studies with extended follow-up are needed to clarify long-term outcomes.