Comparison on the reflux and nutritional status of different reconstruction methods after laparoscopic proximal gastrectomy: a systematic review and network meta-analysis

作者：Chenglin Xin, Zimeng Wang, Zhi Zheng, Shiyong Lu, Xicheng Wei, Jun Zhang, Jie Yin, Zhongtao Zhang · 发表于：Updates in Surgery · 年份：2025 · DOI：10.1007/s13304-025-02324-9 · 被引用次数：2 · 研究领域：Bariatric Surgery and Outcomes、Gastric Cancer Management and Outcomes、Gastroesophageal reflux and treatments

BACKGROUND: The rising prevalence of gastric cancer in the upper third of the stomach has generated considerable interest in laparoscopic proximal gastrectomy (LPG). Traditional esophagogastric anastomosis after LPG has been associated with postoperative reflux issues. Despite the availability of various improved reconstruction techniques, there is still ongoing debate on the optimal approach. This network meta-analysis seeks to assess the reflux and nutritional outcomes associated with various reconstruction techniques subsequent to LPG. METHODS: A comprehensive literature search was performed across five databases: PubMed, Medline, Embase, Cochrane Library, and Web of Science. The reconstruction methods following LPG include esophagogastrostomy (EG), jejunal interposition (JI), jejunal pouch interposition (JPI), double-flap technique (DFT), double-tract reconstruction (DTR), gastric tube reconstruction (GT), and side overlap with fundoplication by Yamashita (SOFY). Network meta-analyses were performed to consolidate outcome measures, such as reflux esophagitis (RE), postoperative reflux symptoms, and nutritional status. RESULTS: This meta-analysis encompasses 16 studies published from 2009 to 2023, involving a total of 1,184 participants and examining 7 distinct reconstruction methods. The results indicated that patients who received DFT [odds ratio (OR) 13.27; 95% confidence interval (CI) 2.86-61.45] had a significantly lower rate of RE compared to those who underwent EG, ...