Karan Bath, MD, Rena Moon, MD, Carolina Ampudia, MD, Samuel Szomstein, MD FACS FASMBS, Raul Rosenthal, MD FACS FASMBS. Cleveland Clinic Florida
Introduction: GIST tumors are being diagnosed with increasing frequency. The location of the tumor plays a crucial role in the approach used for resection and reconstruction.
Materials and Methods: A 53yo F, with morbid obesity, found on preoperative EGD to have a large bilobed mass in fundus suggestive of a GIST.
The patient’s surgery was performed via laparoscopic approach. Intraoperatively, upon exposure of the GE junction, a very large mass in the gastric fundus, abutting the GE junction, was seen. Hence, in order to achieve clear margins, a proximal gastrectomy was performed. Dissection was carried out along the lesser and the greater curvature side of the stomach. The left gastric artery was transected with a white cartridge linear stapler; dissection was also carried out on the lesser curvature side of the stomach taken down the right gastric artery in its most proximal aspect as well as all the branches of the left gastric artery. Stay sutures were placed in the esophagus. The distal esophagus transected with a blue cartridge linear stapler. The stomach was divided with a green cartridge linear stapler and the staple lines oversewn with a running Vicryl suture. A side-to-side esophagojejunostomy between the esophagus and the proximal aspect of the alimentary limb was performed on the posterior wall with a blue cartridge linear stapler. The anastomosis was checked for leakage with air and methylene blue. At this point, a side-to-side jejunojejunostomy between the biliopancreatic limb, which was 50 cm in length, and the alimentary limb was performed with two applications of linear stapler.
Result: The recovery of the patient was uneventful, with a normal UGI on POD1 without leak or obstruction.
Conclusion: Latero-lateral esophago-jejunostomy is a feasible option for reconstruction of GI continuity in patients undergoing proximal or total gastrectomy.
Session Number: VidTV1 – Video Channel Rotation Day 1
Program Number: V097