Short-term outcomes of a novel anti-reflux biologic flap technique versus double flap technique after laparoscopic proximal gastrectomy: a retrospective cohort study

BACKGROUND: The prevalence of proximal gastric cancer continues to rise. Proximal gastrectomy is effective in preserving a favorable postoperative nutritional status, but mitigating postoperative reflux esophagitis poses a formidable challenge. METHOD: We developed a novel anti-reflux procedure for laparoscopic proximal gastrectomy (LPG) using a biologic patch to construct a mechanical anti-reflux barrier, termed the biologic flap technique (BFT). In this retrospective cohort study, patients who underwent LPG at our center between January 2020 and June 2024 were reviewed. Among them, 25 received BFT reconstruction and 54 underwent double flap technique (DFT) reconstruction. Short-term outcomes of the patients were compared to evaluate the clinical application value of BFT. RESULTS: Tumors were more frequently located at the esophagogastric junction and were larger in the LPG-BFT group than in the LPG-DFT group (60.0% vs. 27.8%, P = 0.006; median size 2.5 cm vs. 1.5 cm, P < 0.001). The median operation and anastomosis times were significantly shorter with LPG-BFT (170 min vs. 235 min and 28.0 min vs. 62.5 min, respectively; both P < 0.001). No statistically significant differences were observed in the rates of early and late postoperative complications between the groups, although anastomotic stenosis was less frequent in LPG-BFT (4.0% vs. 9.3%, P = 0.716). Multivariate analysis identified tumor location at the esophagogastric junction and the use of LPG-DFT as independent predictors of longer operation time. Los Angeles grade B or higher reflux esophagitis was observed in 8.7% of LPG-BFT patients and 7.5% of LPG-DFT patients (P = 1.000). CONCLUSION: BFT following LPG is a safe and feasible procedure that can reduce operation time and may provide an alternative for anti-reflux reconstruction when DFT is technically challenging. Favorable short-term clinical outcomes support further evaluation of BFT as an alternative reconstruction technique.