Wei Wang. Guangdong Provincial Hospital of Chinese Medicine
Laparoscopic surgery for gastric gastrointestinal stromal tumors (GISTs) is now widely performed. However, laparoscopic resection of GIST in the esophagogastric junction (EGJ) is technically difficult and rarely reported. When the tumor invaded the esophagogastric line or if the cardia integrity could not be maintained during local resection, laparoscopic proximal gastrectomy was performed. Herein, we reported a laparoscopic proximal gastrectomy with double-flap technique to prevent reflux.
Firstly, the gastrocolic omentum and splenogastric ligament were separated with the gastric greater curvature and fundus mobilized. The left gastric artery was ligated. The lesser curvature and lower esophagus were mobilized. The esophagus was transected laparoscopically.
Secondly, a mini midline incision was used to transect the stomach. The double seromuscular flaps (2.5 cm wide * 3.5 cm high) were cut at the anterior wall of the gastric remnant to cautiously separate the submucosal layer and expose the mucosa.
Thirdly, after creation of the double flap, the inferior end of the mucosal window was cut laparoscopically, and the posterior wall of the esophagus was fixed to the superior edge of the mucosal window. Continuous suturing was performed between the posterior wall of the esophagus and the superior window of the mucosa on the remnant stomach, as well as between the anterior wall of the esophagus and gastric wall at the lower end of the flap. Finally, the anastomosis was fully covered by the seromuscular flaps using continuous suturing [1].
After the anastomotic procedure, intraoperative endoscopy was regularly performed to check the anastomosis.
Reference
[1] Hayami M, Hiki N, Nunobe S, Mine S, Ohashi M, Kumagai K, Ida S, Watanabe M, Sano T, Yamaguchi T. Clinical Outcomes and Evaluation of Laparoscopic Proximal Gastrectomy with Double-Flap Technique for Early Gastric Cancer in the Upper Third of the Stomach. Ann Surg Oncol. 2017 Jun;24(6):1635-1642.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93880
Program Number: V170
Presentation Session: Video Loop Day 1
Presentation Type: VideoLoop