Abstract:Background and Aims Although proximal gastrectomy preserves partial gastric function, postoperative reflux esophagitis and anastomotic stricture remain major challenges. The double-flap technique provides satisfactory anti-reflux efficacy but is limited by impaired blood supply to the seromuscular flap, a relatively high incidence of anastomotic stricture, and technical complexity. Based on the previously developed tunnel anastomosis, we further designed a trapezoid-shaped tunnel anastomosis (tTunnel method). This study aimed to evaluate the safety, feasibility, and short-term efficacy of this modified reconstruction technique after proximal gastrectomy.Methods Clinical data of 30 patients with proximal gastric cancer who underwent radical proximal gastrectomy combined with the tTunnel method at Jiangsu Cancer Hospital between August 2024 and April 2025 were retrospectively analyzed. Operative outcomes, postoperative recovery, perioperative complications, reflux esophagitis, anastomotic stricture, Reflux Disease Questionnaire (RDQ) scores, and endoscopic findings were evaluated.Results All 30 patients successfully underwent proximal gastrectomy with tTunnel reconstruction, including 9 robotic, 17 laparoscopic, and 4 open procedures. The mean operative time was (297.1±82.25) min, tunnel creation time was (8.0±2.05) min, hand-sewn anastomosis time was (52.4±9.59) min, and intraoperative blood loss was (41.3±19.01) mL. R0 resection was achieved in all patients. The overall perioperative complication rate was 20.0% (6/30), with one patient (3.3%) experiencing a Clavien-Dindo grade ≥Ⅲ complication. Follow-up endoscopy revealed anastomotic stricture in 2 patients (6.7%), both classified as outlet-type strictures, while no inlet-type stricture was observed. Reflux esophagitis occurred in 3 patients (10.0%), all of whom had mild disease (Grade A in 1 patient and Grade B in 2 patients). RDQ scores gradually decreased during follow-up, and no patient experienced clinically significant reflux symptoms.Conclusion The tTunnel method is safe and feasible for digestive tract reconstruction after proximal gastrectomy. It provides satisfactory anti-reflux efficacy with a relatively low incidence of anastomotic stricture, particularly reducing the risk of inlet-type stricture. Owing to its simplified procedure, this technique may have promising clinical applicability. However, its long-term outcomes require further validation in large-scale prospective studies.