Fig 1.
Thirty-four patients were enrolled in this study, and the surgical outcomes were compared between the double-flap technique (DFT) and jejunal interposition (JI). Changes in nutritional status and endoscopic findings were evaluated for 28 patients. PPPD, pylorus-preserving pancreatoduodenectomy.
Fig 2.
Schematic of the double-flap technique (DFT) surgical procedure.
(A) An H-shaped seromuscular flap (2.5 × 3.5 cm) was created at the anterior wall of the gastric remnant. (B) After the posterior wall of the esophagus was fixed to the upper edge of the flap, the anastomosis of the posterior wall was sutured. (C) Anastomosis of the anterior wall was sutured continuously with Gambee stitches. (D) The anastomosis was covered with a Y-shape suturing of the flaps, and a valvuloplastic esophagogastrostomy using DFT was completed.
Fig 3.
Schematic of jejunal interposition.
A 10 to 13 cm jejunal limb was raised up through the retrocolic route. An end-to-side esophagojejunostomy was made using a circular stapler and an end-to-side jejunogastrostomy was made in the anterior face of the remnant stomach with Gambee stitches.
Table 1.
Baseline demographics of the patients.
Table 2.
Surgical outcomes and early postoperative complications.
Fig 4.
Comparison of changes in the (A) body weight loss, (B) total protein (TP), (C) albumin (Alb), and (D) hemoglobin (Hb) between the double-flap technique (DFT) and jejunal interposition (JI).
Table 3.
Endoscopic findings at 1 year after surgery.
Table 4.
Postoperative digestive symptoms of the patients.