食管两步切开联合荷包线悬吊优化右开襟单肌瓣吻合在腹腔镜近端胃切除中的初步应用(附视频)OA

Background and Aims:Right-sided overlap and single-flap valvuloplasty(ROSF)is an important reconstruction method after laparoscopic proximal gastrectomy that balances anti-reflux efficacy and functional preservation.However,conventional ROSF still presents technical challenges in esophageal incision,closure of the common opening,and prevention of esophageal stump retraction.This study aimed to evaluate the safety and feasibility of a modified ROSF technique optimized by esophagus two-step-cut combined with purse-string suspension of the esophageal stump. Methods:Clinical data of 33 patients who underwent laparoscopic proximal gastrectomy with modified ROSF reconstruction at the Affiliated Cancer Hospital of Zhengzhou University between August 2024 and December 2025 were retrospectively analyzed.The modified technique included esophagus two-step-cut,purse-string suspension fixation of the esophageal stump,and layered esophageal incision.Perioperative outcomes,postoperative complications,and short-term follow-up results were analyzed. Results:All 33 patients successfully completed the operation without conversion to open surgery or perioperative death.The esophagus two-step-cut technique enabled a neat esophageal incision and satisfactory alignment between the mucosal and muscular layers.Purse-string suspension effectively prevented esophageal stump retraction and improved anastomotic stability.The mean ROSF reconstruction time was(37.9±9.7)min.Intraoperative blood loss was(137.2±45.8)mL.The time to first flatus,first liquid intake,and postoperative hospital stay were(2.1±0.5)d,(5.9±0.3)d,and(10.0±3.2)d,respectively.Perioperative complications occurred in 4 patients(12.1%),all classified as Clavien-Dindo grade Ⅰ-Ⅱ,including pneumonia in 2 patients,acute coronary syndrome in 1 patient,and fat liquefaction of the incision in 1 patient.All recovered after conservative treatment.No anastomotic leakage,anastomotic bleeding,or anastomotic stenosis occurred.During a median follow-up of 5.0(1.0-12.0)months,no tumor recurrence or distant metastasis was observed.Only 1 patient developed mild reflux symptoms,which were relieved with medication. Conclusion:Esophagus two-step-cut combined with purse-string suspension can optimize the ROSF procedure by improving anastomotic stability and reducing operative difficulty.This modified technique is safe and feasible for laparoscopic proximal gastrectomy and demonstrates satisfactory short-term outcomes.