- Malignant tumors.
- Benign tumors.
- Intractable bleeding.
- Chronic ulceration and inflammation.
- Inability to completely resect primary cancer.
- Distant metastases.
- High operative risk because of age or comorbidities.
- Operative mortality rates range from 3%–7%.
- Resection of the spleen, pancreas, or colon may be required if a gastric tumor has invaded adjacent organs.
- Surgical treatment of gastric malignancy with curative intent.
- Resolution of bleeding or obstruction from benign or malignant gastric tumors or disease processes.
- Anastomotic leak.
- Wound infection.
- Pancreatic fistulae.
- Intra-abdominal abscesses.
- A self-retaining retractor is necessary for optimal exposure.
- Gastrointestinal anastomosis (GIA), thoracoabdominal (TA), and end-to-end anastomosis (EEA) staplers are often used for resection and reconstruction, and should be available.
- All patients should undergo fiberoptic endoscopy when neoplasm is suspected, and the diagnosis should be confirmed by multiple biopsies.
- Preoperative tests should be performed to determine whether distant metastases are present.
- Abdominal and pelvic CT scans, endoscopic ultrasound, or laparoscopy may be required for adequate staging.
- A first- or second-generation cephalosporin is adequate as antibiotic prophylaxis for most gastric operations.
- Deep venous thrombosis prophylaxis should be administered.
- Bowel preparation is only useful in complicated cases when intestinal decompression is required and may serve to lessen the bacterial load if an intestinal resection is required.
- Electrolyte and coagulation deficits should be corrected before operation.
- The patient should be supine, with the operating surgeon on the right side of the patient.
- An upper midline incision is made from the xiphoid to the umbilicus to enter the abdomen.
- Reverse Trendelenburg positioning facilitates exposure.
- Once the abdomen has been entered, a routine exploration should be performed and a nasogastric tube placed by the anesthetist.
Overview and Surgical Anatomy
- Figure 6–1A-C: Overview of surgical options for resection of gastric lesions.
- For lesions involving the cardia of the stomach, esophagogastrectomy with esophagogastrostomy is performed (Figure 6–1A). A thoracotomy combined with laparotomy may be required. To ensure blood supply to the gastric remnant, the right gastroepiploic vessels are preserved.
- For lesions in the body of the stomach, total gastrectomy with esophagojejunostomy is typically performed (Figure 6–1B).
- For antral lesions, subtotal gastrectomy with gastrojejunal reconstruction is performed (Figure 6–1C).
- Figure 6–2: Surgical anatomy of the stomach.
- The esophagus terminates in the stomach after penetrating the diaphragm at the esophageal hiatus.
- The stomach is divided into the fundus, body, and antrum based on differences in mucosal histology.
- The fundus lies to the left and superior to the esophagogastric junction.
- The junction of the body and antrum is approximately 6–8 cm proximal to the pylorus along the lesser curvature, to a point one-third the distance from the pylorus to the esophagogastric junction along the greater curvature.
- Subtotal ...
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