Tapia-Vega MA, Morales-Chávez CE, Aguirre-Olmedo I, Cuendis-Velázquez A, Rojano-Rodríguez ME, Cárdenas-Lailson LE

Language: Spanish
References: 9
Page: 150-156
PDF size: 401.45 Kb.

ABSTRACT

Background: Gastric neoplasms can be treated by laparoscopy in a safe and efficient way. Some lesions are not accessible to laparoscopic surgery due to their location. A transgastric approach is proposed as an alternative.
Objective: Show the results with the application of an endoscopic laparotomy in an animal model that maintains functional anatomy, to resect the posterior gastric neoplasms of the stomach wall, close to the cardia and pre-pyloric region.
Methods: The laparo-endoscopic technique for resection of gastric neoplasms located in the posterior wall was developed in twelve pigs at the Hospital General Gea González from May to December 2011. Technique: An endoscopy was performed to establish the site of insertion of intragastric trocars. Three gastrotomies were made in the anterior wall; under endoscopic and laparoscopic vision the trocars were inserted. The stomach was insufflated with CO₂. The lesion was resected maintaining a 20 mm circumferencial margin. The gastrotomies were sutured. The statistic analysis was made with t Student and exact Fisher tests.
Results: One-hundred percent of resections were achieved in an average time of 102.33 minutes (± 4.50). Two complications and no transoperatory deceases occurred.
Discussion: The technique we describe allows an appropriate approach to gastric lesions located in the posterior wall, those near to the esophagogastric juntion and the prepiloric region, due to the excellent exposure managed by working inside the stomach with a laparoscopic vision and the two intragastric movile ports.
Conclusions: The laparoscopic transgastric approach is feasible and safe for the resection of gastric neoplasms located in the posterior wall, those close to the esophago-gastric junction, and the pre-pyloric region.

REFERENCES

1. Spivak H, Hunter JG. Endoluminal surgery. Surg Endosc 1997;11:321-325.

2. Matthews BD, Walsh RM, Kercher KW, Sing RF, Pratt BL, Answini GA, et al. Laparoscopic vs open resection of gastric stromal tumors. Surg Endosc 2002;16:803-807.

3. Shim JH, Lee HH, Yoo HM, Jeon HM, Park CH, Kim JG, et al. Intragastric approach for submucosal tumors located near the Z-line: A hybrid laparoscopic and endoscopic technique. J Surg Oncol 2011;104:312-315.

4. Ohashi S. Laparoscopic intraluminal (intragastric) surgery for early gastric cancer. A new concept in laparoscopic surgery. Surg Endosc 1995;9:169-171.

5. Taniguchi E, Kamiike W, Yamanishi H, Ito T, Nezu R, Nishida T, et al. Laparoscopic intragastric surgery for gastric leiomyoma. Surg Endosc 1997;11:287-289.

6. Taniguchi E, Ohashi S, Takiguchi S, Yumiba T, Itoh T, Matsuda H, et al. Laparoscopic intragastric surgery using a radially expandable sleeve. Surg Endosc 2000;14(5):505- 507.

7. Otani Y, Ohgami M, Igarashi N, Kimata M, Kubota T, Kumai K, et al. Laparoscopic wedge resection of gastric submucosal tumors. Surg Laparosc Endosc Percutan Tech 2000;10:19- 23.

8. Röthlin M, Schöb O. Laparoscopic wedge resection for benign gastric tumors. Surg Endosc. 2001;15:893-895.

9. Tada M, Murakami A, Karita M, Yanai H, Okita K. Endoscopic resection of early gastric cancer. Endosc 1993;25:445- 450.