Introduction of robot-assisted double-flap esophagogastrostomy after proximal gastrectomy: an exploratory comparison with side-overlap reconstruction
- 1Department of Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Yahaba, Iwate 0283695 Japan
- 2Department of Medical Safety, Iwate Medical University School of Medicine, Yahaba, Iwate, 0283695 Japan
Abstract
Purpose: Proximal gastrectomy (PG) is a function-preserving option for early gastric cancer located in the upper third of the stomach. We introduced robot-assisted valvuloplastic esophagogastrostomy (VEG) using the double-flap technique (DFT) and retrospectively compared its short-term outcomes with those of side-overlap (SO) reconstruction, with particular attention to postoperative reflux and nutritional changes.
Methods: A total of 24 patients who underwent robot-assisted PG with VEG between January 2020 and July 2024 were retrospectively reviewed. Fourteen patients underwent VEG-SO and 10 underwent VEG-DFT.
Results: Operative time, blood loss, and the incidence of Clavien–Dindo grade II or higher complications did not differ significantly between the groups. Contrast studies showed no reflux in either group. At 6 months, modified Los Angeles grade A or higher reflux esophagitis was observed in 7 of 14 patients in the SO group and 1 of 10 patients in the DFT group (50.0% vs. 10.0%, P = 0.031). No anastomotic stenosis occurred; one patient in the SO group developed anastomotic leakage. The percentage body weight loss was greater in the DFT group (P = 0.034), whereas changes in laboratory-based nutritional indices did not differ significantly between the groups.
Conclusion: In this small retrospective cohort, robot-assisted VEG-DFT was not associated with an apparent increase in short-term perioperative morbidity compared with VEG-SO. Reflux esophagitis was less frequent after DFT, whereas body weight loss at 6 months was greater. These findings are exploratory, and the mechanism and clinical relevance of the difference in weight loss remain uncertain.
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BibTeX
@article{takahashi2026introduction,
title = {{Introduction of robot-assisted double-flap esophagogastrostomy after proximal gastrectomy: an exploratory comparison with side-overlap reconstruction}},
author = {Naoto Takahashi and Shigeaki Baba and Haruka Nikai and Ryosuke Fujisawa and Masaki Kanno and Keisuke Koeda and Hiroyuki Nitta and Akira Sasaki},
journal = {Langenbeck's Archives of Surgery},
year = {2026},
month = aug,
doi = {10.1007/s00423-026-04193-1},
url = {https://doi.org/10.1007/s00423-026-04193-1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Introduction of robot-assisted double-flap esophagogastrostomy after proximal gastrectomy: an exploratory comparison with side-overlap reconstruction
AU - Naoto Takahashi
AU - Shigeaki Baba
AU - Haruka Nikai
AU - Ryosuke Fujisawa
AU - Masaki Kanno
AU - Keisuke Koeda
AU - Hiroyuki Nitta
AU - Akira Sasaki
PY - 2026
DA - 2026/08/07
JO - Langenbeck's Archives of Surgery
DO - 10.1007/s00423-026-04193-1
UR - https://doi.org/10.1007/s00423-026-04193-1
AB - Purpose: Proximal gastrectomy (PG) is a function-preserving option for early gastric cancer located in the upper third of the stomach. We introduced robot-assisted valvuloplastic esophagogastrostomy (VEG) using the double-flap technique (DFT) and retrospectively compared its short-term outcomes with those of side-overlap (SO) reconstruction, with particular attention to postoperative reflux and nutritional changes. Methods: A total of 24 patients who underwent robot-assisted PG with VEG between January 2020 and July 2024 were retrospectively reviewed. Fourteen patients underwent VEG-SO and 10 underwent VEG-DFT. Results: Operative time, blood loss, and the incidence of Clavien–Dindo grade II or higher complications did not differ significantly between the groups. Contrast studies showed no reflux in either group. At 6 months, modified Los Angeles grade A or higher reflux esophagitis was observed in 7 of 14 patients in the SO group and 1 of 10 patients in the DFT group (50.0% vs. 10.0%, P = 0.031). No anastomotic stenosis occurred; one patient in the SO group developed anastomotic leakage. The percentage body weight loss was greater in the DFT group (P = 0.034), whereas changes in laboratory-based nutritional indices did not differ significantly between the groups. Conclusion: In this small retrospective cohort, robot-assisted VEG-DFT was not associated with an apparent increase in short-term perioperative morbidity compared with VEG-SO. Reflux esophagitis was less frequent after DFT, whereas body weight loss at 6 months was greater. These findings are exploratory, and the mechanism and clinical relevance of the difference in weight loss remain uncertain.
SN - 1435-2443
SN - 1435-2451
ER -