Laparoscopic proximal gastrectomy, lympadenectomy and jejunal interposition for Gastric adenocarcinoma.

Mohan Ramalingam, MD, Nestor De La Cruz-Munoz, MD. University of Miami

Patient is a 53 yo female with gastric cardia adenocarcinoma treated with neoadjuvant chemotherapy, now presenting for proximal gastrectomy.

We performed a proximal hemi-gastrectomy with lymphadenectomy and to bridge the gap between the esophagus and distal stomach, brought a vascularized 15cm pedicled flap of jejunum, tunnelled it through a meso-colonic defect and performed an end-to-side esophago-jejunostomy and a side-to-side gastro-jejunostomy. A side-to-side functional end-to-end jejuno-jejunostomy was formed to recreate small intestinal continuity. The mesenteric defects were all sutured closed. A laparoscopic jejunostomy tube was created for distal feeding access.

Proximal gastrectomy is prevalent in Asia, especially Japan but not commonly performed in North America. We detail our technique for a laparoscopic approach for a procedure that could become the standard of care for early, proximal gastric cancer.

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