Laparoscopic Gastric Wedge Resection With Prophylactic Fundoplication for Submucosal Tumor at Gastroesophageal Junction

Jin-jo Kim, MD, Jung-sun Lee, MD. Incheon St. Mary’s Hospital, The Catholic University of Korea


Objective: Laparoscopic gastric wedge resection (LGWR) for a gastric submucosal tumor (SMT) which involved gastroesophageal junction (GEJ) is technically challenging because of difficulty in reconstruction of GEJ after resection and resultant damaged function of lower esophageal sphincter (LES). We report our surgical results of LGWR with prophylactic fundoplication in order to evaluate its clinical usefulness.

Method: Four consecutive patients who underwent LGWR with prophylactic fundoplication at our institution from February, 2011 to September, 2011 were enrolled into this study. There were 2 male patients and 2 female patients with mean age of 62. The peripheral margin of SMT of the patients involved GEJ, except for that of one patient. The SMT of this patient was located at 1cm beside the angle of His and the patient has suffered from gastroesophageal reflux disease (GERD) with her hiatal hernia. None of the rest had suffered from GERD, preoperatively. All SMT’s of the patients were suspected as a gastrointestinal stromal tumor (GIST) in preoperative study. After resection of tumor, GEJ was reconstructed with 2-layered interrupted or continuous intracorporeal suturing or both. After reconstruction of GEJ, crural repair and partial or total fundoplication (2 Dor, 1 Toupet, 1 Collis-Nissen) were performed.

Results: The average size of the SMT was 4cm and the pathologic results were GIST in 3 patients and leiomyoma in 1 patient. The mean operation time was 244 minutes and oral feeding was started at 3rd postoperative day. The mean postoperative hospital stay was 7 days. There were no postoperative morbidity nor mortality. During the mean 5 months of postoperative follow up, all patients eat very well without any difficulty of swallowing, without symptom of GERD.

Conclusion: LGWR with prophylactic fundoplication for SMT at GEJ was safe and clinically useful. It can be a good surgical option for those patients instead of total or proximal gastrectomy.

Session Number: Poster – Poster Presentations
Program Number: P198
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