Laparoscopic Sleeve Gastrectomy for Morbid Obesity and Multiple GISTs – The Rendezvous Technique

Sharon Shiraga, MD, Joerg Zehetner, MD, Nicolai Bildzukewicz, MD, Kulmeet Sandhu, MD, Peter Crookes, MD, John Lipham, MD, Namir Katkhouda, MD. USC

This is a video case presentation of laparoscopic sleeve gastrectomy in a patient with morbid obesity and multiple gastrointestinal stromal tumors (GISTs) using the rendezvous technique for tumor localization. The patient underwent routine bariatric surgery workup and his upper endoscopy revealed multiple gastric GISTs along the greater curvature of the stomach. A sleeve gastrectomy was the patient’s choice of bariatric treatment. We needed to make sure that, intra-operatively, the sleeve gastrectomy would sufficiently remove all the tumors. Otherwise, we would perform a total gastrectomy. We started the procedure with a laparoscopic gastrotomy and upper endoscopy. The gastrostomy provided direct view of the intraluminal tumors with orientation to the greater curvature while the upper endoscopy confirmed the location with special concentration on the fundus on retroflexion. With duo-imaging rendezvous technique, we established that all tumors were along the greater curvature with good margin away from the proposed sleeve gastrectomy area. This gave us the essential information that a sleeve gastrectomy was sufficient to treat both disease processes. The procedure went very well as shown in the video. The patient had good outcomes with weight loss, resolution of diabetes and complete tumor resection.

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