Case Report: a Novel Reconstruction Method (Itihaas’s Anastomosis) for Proximal Gastrectomy

Abstract This study introduces a novel reconstruction method (Itihaas’s Anastomosis) for the upper gastrointestinal (UGI) tract following proximal gastrectomy, designed to mitigate the severity of acid reflux syndrome, a frequent postoperative complication. The procedure comprises three side-to-side anastomoses: esophago-gastrostomy, gastro-jejunostomy, and jejuno-jejunostomy. The esophago-gastrostomy anastomosis aims to prevent direct reflux of gastric contents into the esophagus by creating a fundus-like structure, which also facilitates future endoscopic procedures. The gastro-jejunostomy reduces acid reflux by diverting gastric acid to the jejunum for further neutralization, while the jejuno-jejunostomy prevents bile and pancreatic juice reflux into the stomach. A 75-year-old male with adenocarcinoma of the upper stomach underwent this surgical procedure. Postoperative outcomes showed no major complications, with smooth oral contrast passage and no evidence of anastomotic leaks. The patient was discharged after resuming semi-solid food and experienced no signs of reflux. Itihaas’s Anastomosis appears promising in reducing acid reflux and improving postoperative quality of life for patients undergoing proximal gastrectomy, balancing natural anatomical and physiological preservation with reflux reduction, potentially offering a better alternative to other conventional anastomoses. Further studies are needed to validate these findings and compare long-term outcomes with existing techniques.