Laparoscopy-assisted Proximal Gastrectomy with Double Tract Anastomosis Is Beneficial for Vitamin B12 and Iron Absorption

BACKGROUND: Double tract anastomosis (DTA) is a recently revisited reconstruction method for preventing reflux esophagitis in laparoscopy-assisted proximal gastrectomy (LAPG). However, only few studies have shown the advantages of LAPG-DTA. PATIENTS AND METHODS: Seventeen patients underwent LAPG-DTA compared to 17 patients undergoing laparoscopy-assisted total gastrectomy (LATG) matched with preoperative stage. Laboratory results, including hemoglobin, serum ferritin, serum iron and vitamin B12, were compared. RESULTS: Reflux esophagitis developed in two and one patient in the LAPG-DTA and LATG groups, respectively. In the laboratory analysis, fewer patients experienced decrease of serum ferritin below the low normal limit in the LAPG-DTA group. There was a significantly lower proportion of patients in the LAPG-DTA group whose vitamin B12 level decreased below the low normal limit. CONCLUSION: LAPG-DTA has the advantages of allowing absorption of iron and vitamin B12 without reflux esophagitis in proximal early gastric cancer compared to LATG.