Ryan Fairley, DO1, Danial Cottam, MD2, Helmuth T Billy, MD1. 1Community Memorial Hospital, Ventura California, 2Bariatric Medical Institute, Salt Lake City, Utah
Large submucosal intragastric neoplasms can be difficult to resect endoscopically. Laparoscopic resection of gastric neoplasms often require partial gastrectomy with complex reconstruction. Complications including gastric paresis, gastric and bile reflux are often consequences of billroth I and II reconstructions. Preservation of total gastric volume when approaching submucsal lesions while obtaining complete resection with clear margins is a desireable outcome when approaching large intragastric lesions.
A 70 year old otherwise healthy man presented with a large, 6-8 cm gastric lesion, not amenable to endoscopic resection. presented for surgical and laparoscopic resection. The lesion was located along the lesser curve in the midbody of the stomach and extended from the distal cardia to the angularus incissura.
Laparoscopic resection was undertaken with the goal of preserving total gastric volume and avoiding partial gastrectomy necessitating reconstruction. Laparoscopic approach using a four trocar technique and internal liver retraction using a three hook trapeeze approach was perfromed. A left lateral subcostal 5 mm trocar, left mid abdominal 12mm trocar, umbilical 12 mm trocar and right epigastric 5 mm trocar were employed. Intraoperative EGD confrimed the location of the mass in a submucosal location along the lesser curve.
Using a 3 cm gastrotomy on the anterior gastric wall between the angularus and the greater curve the gastric mass was successfully delevered through the gastrotomy. Using a 60 mm stapler the mass was successfully resected using two firings of the stapler across the mucosal base of the lesion. The lesion was successfully removed from the gastric wall without compromising lesser curve blood supply. The stomach was not resected and total gastric volume was preserved. The small gastrotomy was closed laparoscopically in two layers. Intraoperative completion endosco;y confirmed no intragastric bleeding along the line of resection and no leakage along the lesser curve or the site of the gastrotomy. Total operative time was 45 minutes.
The pateint had an uneventful recovery and was tolerating clear liquids on post operative day one and was discharged on post operative day two. There were no complications and the patient had a full recovery. Final pathology was consistent with a benign large submucosal lipoma. Surgical margins were clear and the lipoma was completely resected
Resection of large submucosal gastric wall lesions can be resected without compromise of gastric wall volume
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95944
Program Number: P464
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster