Laparoscopic resection of submucosal tumor on posterior wall of gastric fundus.
OBJECTIVE
Laparoscopic resection of tumors on the posterior wall of gastric fundus, especially when they are next to the esophagocardiac junction (ECJ), is both difficult and time-consuming. Furthermore, it can lead to inadvertent esophagus stenosis and injury to the spleen. In order to overcome these difficulties, laparoscopically extraluminal resection of gastric fundus was designed to manage submucosal tumors located on the posterior wall of gastric fundus and next to ECJ.


METHODS
From January 2001 to September 2003, laparoscopically extraluminal resection of gastric fundus was successfully carried out on 15 patients. There were 11 males and 4 females with an average age of 58 years (range, 38 to 78 years). The mean diameter of the tumors was 4.8 cm. The distance of the tumor border from ECJ was about 1.5-2.5 cm. The four-portal operation procedures were as follows: localization of the tumor, dissection of the omentum, mobilization of the gastric fundus and the upper polar of spleen, exposure of ECJ, and resection of the gastric fundus with Endo GIA.


RESULTS
The laparoscopic operation time averaged (66.2+/-10.4) min, the average amount of bleeding was (89.4+/-21.7) mL. The mean post-operative hospital stay was (5.3+/-1.1) d. Within 36 h post-operation, 73.3% of all the patients recovered their gastrointestinal function and began to eat something and to walk. In all the operations, no apparent tumor focus was left and no complication or conversion to open surgery occurred.


CONCLUSIONS
Our newly designed procedure, laparoscopically extraluminal resection of the gastric fundus, can avoid contamination of the abdominal cavity, injury to the spleen and esophageal stenosis. The procedure seems to be both safe and effective.
Ke
Zhong-Wei
ZW
Department of Minimally Invasive Surgery, Changhai Hospital, Second Military Medical University, 174 Changhai Road, Shanghai 200433, China. weiz@miscenter.cn
Zheng
Cheng-Zhu
CZ
Hu
Ming-Gen
MG
Chen
Dan-Lei
DL
D000328:Adult; D000368:Aged; D005260:Female; D005748:Gastric Fundus; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome