A modified double tract reconstruction with the NI method following proximal gastrectomy: a novel approach to prevent reflux and preserve nutritional status.

Abstract

Background: Double-tract reconstruction is commonly performed after proximal gastrectomy to prevent gastroesophageal reflux and ensure adequate nutrition. We developed a modified double-tract reconstruction intervention, denominated the NI method, in which the anastomosis between the remnant stomach and jejunum was strategically configured to optimize food passage and suppress gastroesophageal reflux.

Methods: This retrospective study included patients with upper-third gastric cancer and adenocarcinoma of the esophagogastric junction who underwent proximal gastrectomy with either conventional or NI-modified double-tract reconstruction at two institutions. Postoperative outcomes, including body weight loss and incidence of reflux esophagitis, were compared.

Results: In total, 115 patients underwent proximal gastrectomy with double-tract reconstruction, including 35 with the NI method and 110 using the conventional method. No significant differences were observed in the baseline characteristics between the two groups. The incidence of reflux esophagitis was significantly lower in the NI group (0% vs. 14.3%, P = 0.032). Although not statistically significant, the NI group showed consistently lower weight loss rates, with approximately 2% less reduction at both 6 and 12 months after surgery.

Conclusions: The NI-modified double-tract reconstruction is a safe and function-preserving technique for proximal gastrectomy. The unique gastrojejunostomy design may contribute to reduce reflux and achieve better nutritional outcomes by restoring more physiological food passage.