title: Laparoscopic intragastric surgery and laparoscopic roux-y gastric bypass were performed simultaneously on a morbidly obese patient with a gastric submucosal tumor: a report of a case and review.
abstract: BACKGROUND
  Obesity patients sometimes have gastric submucosal tumors (SMTs). Surgical excision is recommended in cases of SMTs with suspected malignancy or other reasons making follow-up difficult. Laparoscopic intragastric surgery (LIGS) has recently achieved good results in the treatment of gastric SMTs, especially near the esophagogastric junction (EGJ). This procedure has enabled either preservation of the stomach or minimization of the extent of partial resection.
  
  
  METHODS
  The patient is a 43-year-old female with BMI of 48.2 kg/m(2) who is a candidate for LRYGB. A small SMT was found just below the EGJ. A follow-up with an endoscopy would be needed but difficult because the pouch was too small to observe the lesion. We decided to resect the tumor with LIGS and perform LRYGB simultaneously.
  
  
  RESULTS
  We put the trocars as is our usual LRYGB practice. Observing with laparoscopy and endoscopy, three trocars were inserted into the stomach. After marking the margin of the tumor and injecting normal saline to the submucosal layer, resection of the tumor was performed. Suturing of the defects of the mucosa and the holes of the trocars on the stomach was performed. Then, we performed LRYGB as usual. The patient was discharged uneventfully. The pathological findings showed that the tumor was resected completely. Weight loss has succeeded as her BMI is 32.7 at 1 year after the surgery.
  
  
  CONCLUSIONS
  We performed LIGS and LRYGB simultaneously and safely for a morbidly obese patient with a gastric SMT, and our case is the first case of LIGS during a bariatric procedure.
authors.affiliation: Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan, k-hashimoto@mcube.jp.
authors.forename: Kenkichi
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Seki
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kasama
mesh_terms: D000328:Adult; D004943:Esophagogastric Junction / Q000601:surgery; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008067:Lipoma / Q000150:complications / Q000601:surgery*; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*; D013537:Sutures; D016896:Treatment Outcome; D015431:Weight Loss