Objective: To investigate the feasibility and safety of modified interposed jejunal anastomosis following total laparoscopic proximal gastrectomy. Methods: The modification in the digestive tract reconstruction involves transecting the small intestine 2-3 cm below the gastrojejunostomy site and relocating the enteroenterostomy cranially, based on the double-tract anastomosis technique. Specifically, the jejunum and its mesenteric vessels are transected 20-25 cm from the ligament of Treitz. An overlap anastomosis is performed between the esophagus and the distal jejunum, with the common opening closed using a 15 cm barbed suture in a buried manner. A side-to-side gastrojejunostomy is completed under natural anatomical alignment, and the common opening is closed similarly. A side-to-side anastomosis is then created between the small intestine approximately 10 cm below the gastrojejunal anastomosis and the small intestine distal to the ligament of Treitz. Finally, the small intestine is transected 2-3 cm below the gastrojejunal anastomosis without dividing the mesenteric vessels. Results: From April to December 2024, a total of five patients with adenocarcinoma of the esophagogastric junction underwent modified interposed jejunum anastomosis following totally laparoscopic proximal gastrectomy at the Affiliated Tumor Hospital of Xinjiang Medical University. The median age of the group was 56 (53-74) years, including four males and one female, with a median body mass index of 24 (21-29) kg/m². Three cases were classified as Siewert type II and two as type III. All five patients successfully completed the totally laparoscopic proximal gastrectomy with modified interposed jejunum anastomosis. The median operative time was 215 (165-240) minutes, the digestive tract reconstruction time was 75 (65-93) minutes, and the intraoperative blood loss was 50 (30-100) ml. The median time to postoperative flatus was 71 (68-88) hours, with no severe complications occurring in any case. The median postoperative hospital stay was 8 (8-9) days. Within three months after surgery, none of the patients reported reflux symptoms such as acid regurgitation or heartburn. Conclusions: Total laparoscopic modified interposed jejunal anastomosis is safe and feasible, with relatively simple operative steps. It effectively prevents reflux while ensuring the passage of food through the remnant stomach and duodenal loop.
Humans ; Gastrectomy/methods* ; Jejunum/surgery* ; Laparoscopy/methods* ; Anastomosis, Surgical/methods* ; Male ; Female ; Middle Aged ; Aged ; Stomach Neoplasms/surgery* ; Plastic Surgery Procedures/methods*

BACKGROUND:Adipose stem cells can differentiate into bone cells, cartilage cells, smooth muscle cells, myocardial cells and nerve cells. Adipose-derived stem cells and mesenchymal stem cells have very similar biological properties, and they are also very close in terms of cellsurface marker expression profile. OBJECTIVE:To investigate the expression of human leukocyte antigen II in adipose-derived stem cells and its immunogenicity and immunomodulatory effect, and to explore the specific mechanism. METHODS:After isolation and culture, the adipose-derived stem cells were stimulated with interferon-γ, and the expression of human leukocyte antigen II was detected by flow cytometry, the expression of indoleamine 2,3-dioxygenase was determined by real-time PCR and western blot. Adipose-derived stem cells were used to stimulate lymphocytes, and the cellproliferation was observed. The lymphocytes were stimulated with phytohemagglutinin, and then 1×102-1×105 adipose-derived stem cells were added to inhibit the proliferation;meanwhile, adipose-derived stem cells, a third party, at a dose of 1×102-1×105 were added to the ongoing two-way mixed lymphocyte reaction, and the cellnumber was calculated as count per minute. RESULTS AND CONCLUSION:The expression of human leukocyte antigen II and indoleamine 2,3-dioxygenase was low in adipose-derived stem cells, but up-regulated with stimulation of interferon-γ. Adipose-derived stem cells could not stimulate lymphocyte proliferation, but could inhibit lymphocyte proliferation induced by phytohemagglutinin or al ogeneic lymphocytes, and interferon-γwas highly expressed in the supernatant of co-culture of adipose-derived stem cells and mixed lymphocytes. These results indicate that the adipose-derived stem cells have low immunogenicity and can inhibit cellproliferation of lymphocytes in vitro, and the addition of exogenous interferon-γcan enhance the immunosuppressive effects of adipose-derived stem cells.