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Although the double-flap technique (DFT) is effective in preventing reflux after PG, procedural complexity and flap manipulation may contribute to longer reconstruction time and anastomotic stenosis, especially in robotic-assisted procedures. This study aimed to evaluate the non-flap tunnel technique (NFTT) as a simplified alternative to DFT with respect to operative efficiency and anastomotic integrity.  \nMethods: We retrospectively reviewed patients who underwent minimally invasive PG at a single institution between January 2019 and November 2024. Surgical outcomes, including reconstruction time, incidence of anastomotic stenosis, and reflux symptoms, were compared between the DFT and NFTT groups using 2:1 propensity score matching.  \nResults: After matching, 62 patients in the DFT group and 31 patients in the NFTT group were included. NFTT was associated with shorter reconstruction time (87 vs. 108 min; p = 0.004) and a lower incidence of anastomotic stenosis requiring balloon dilation (3.2% vs. 29.0%; p = 0.003). This difference in stenosis rate remained significant in robot-assisted cases (2.5% vs. 30.8%; p = 0.008). No reflux symptoms were observed in the NFTT group, compared to 6.5% in the DFT group (p = 0.30) .  \nConclusion: NFTT reduced reconstruction time and anastomotic stenosis while maintaining anti-reflux efficacy. These results support NFTT as a technically feasible and effective alternative to DFT for reconstruction following minimally invasive PG. Prospective studies are warranted to validate long-term outcomes.  \n\n| Masaru Hayami and Qingjiang Hu contributed equally to this study. |\n| --- |\n| This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.\u003Cbr>© 2025 The Author(s). Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterological Surgery. |\n\nAnnals of Gastroenterological Surgery, 2026; 10:87–94 87  \n[https://doi.org/10.1002/ags3.70072](https://doi.org/10.1002/ags3.70072)  \n1 | Introduction  \nThe incidence of upper-third gastric cancer and esophagogastric junction (EGJ) cancer has been increasing, necessitating the adoption of function-preserving surgical procedures such as proximal gastrectomy (PG) [1, 2] . In comparison with total gastrectomy, PG has been shown to better preserve postoperative nutritional status and quality of life (QoL) [3] . Nevertheless, the optimal method of reconstruction following PG remains a subject of debate, primarily given the occurrence of complications such as anastomotic stenosis and reflux esophagitis [1, 2, 4] .  \nThe double-flap technique (DFT) is widely regarded as an effective anti-reflux reconstruction metho","cbCaiv3JC1UITtiA","https://ap.wps.com/l/cbCaiv3JC1UITtiA","pdf",526316,"English","# Abstract\n# Introduction\n# Materials and Methods","[{\"question\":\"What problem does the non-flap tunnel technique (NFTT) aim to address after proximal gastrectomy?\",\"answer\":\"NFTT is proposed as a simplified alternative to the double-flap technique to improve operative efficiency and maintain anastomotic integrity, addressing complexity-related delays and stenosis risk.\"},{\"question\":\"How was the study designed to compare DFT and NFTT?\",\"answer\":\"A retrospective review was conducted for minimally invasive proximal gastrectomy from January 2019 to November 2024, with outcomes compared between groups using 2:1 propensity score matching.\"},{\"question\":\"What were the main outcome differences between NFTT and DFT after matching?\",\"answer\":\"NFTT showed shorter reconstruction time (87 vs. 108 minutes) and a lower rate of anastomotic stenosis requiring balloon dilation (3.2% vs. 29.0%). The lower stenosis rate also remained significant in robot-assisted cases.\"}]","Non-Flap Tunnel Technique (NFTT) - A Novel Minimally Invasive Reconstruction Method After Proximal Gastrectomy | PDF",1790594994]