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Purpose. To clarify the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with our novel reconstruction methods, clinical outcomes of this LPG were evaluated and compared to those of LPG with our conventional method. Methods. Novel method is a reconstruction with a long and narrow gastric tube with widening of the proximal side of the gastric tube created by linear stapler. Esophagogastrostomy is performed by direct anastomosis with overlap method between the posterior wall of the esophagus and anterior wall of the gastric tube using a linear stapler. In conventional method, direct anastomosis between the esophagus and a gastric tube by a circular stapler was performed. Short- and long-term outcomes of a novel method were compared with those of conventional method. Results. A total of 39 patients whom LPG was performed were enrolled in this retrospective study. The amount of blood loss in the Novel method group (n = 30) was significantly less than those in the Conventional method group (n = 9) (40 vs. 110 ml, p < 0.01). No cases of anastomotic leakage and stenosis were observed in both groups. The cases of postoperative reflux esophagitis at 1 year after operation in the Novel group were less than those in the Conventional group (10% vs. 33%). In the Novel group, postoperative recurrence was observed in 2 patients (7%). Conclusion. LPG with novel reconstruction method using long and narrow cobra- head-shaped gastric tube can be easily performed, and may be feasible for the treatment of gastric cancer in the upper third of the stomach.

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Case: A 64-year-old female was found lying by a river. She was unconscious and her lower body was under water. The patient was transported to the emergency room of our hospital. On arrival, her rectal temperature was 24.6°C. We immediately started rewarming and artificial respiration. Five days after admission, rewarming was completed and she became conscious and could communicate. Initially, she had been injured and examination showed paraplegia. Magnetic resonance imaging of her cervical spine showed no findings indicating bony or ligament injury, but there was a T2 high intensity area at C5/6 and C6/7 levels. The patient was diagnosed with spinal cord injury without radiological abnormality.Outcome: At 5 months post-injury, the patient was able to walk without crutches. Conclusion: Spinal cord injury might be missed if there are no radiographic abnormalities. Spinal cord injury without radiological abnormality should be considered as a differential diagnosis of accidental hypothermia.