Objective:
Removal of the lesion with safe surgical margins is often sufficient including GISTs. Endoscopic resections can become challenging or impossible if the tumor is located near esophagogastric junction. Performing gastrectomy for these mostly benign lesions will also be a rather overtreatment method in most cases.Therefore, alternative minimal invasive resection techniques and their reliability should be evaluated.
The aim of this study is to evaluate the efficacy and safety of endoscopy-assisted laparoscopic transgastric resection method in proximally located submucosal tumors.
Method:
Transgastric combined endoscopic and laparoscopic surgery (CELS) using an intragastric port was performed in one patient and transgastric CELS with gastrotomy was performed in six patients who had tumor located near esophagogastric junction at Ankara City Hospital between February 2019 and February 2020.
Results:
Three male, and 4 female patients with an average age of 45.8 years (range 25-70) were included in the study. In five of the cases, four ports and Nathanson retractor were used for liver retraction. Three ports were used in one patient, and the stomach was suspended with traction suture. In one patient, 5 ports were used. The average operation time was 88 minutes (range 59-140 min). While gastrostomy line was closed with linear stapler in two patients, laparoscopic suturing method was used in the remaining patients. Intraoperative complication was not seen in any patient.
Conclusion:
We are in the opinion that the laparoscopic transgastric resection approach for submucosal tumors close to the gastroesophageal junction, is a feasible and safe method, when used in combination with endoscopic guidance.
Keywords: Esophagogastric junction, gastric submucosal tumors, transgastric combined endoscopic and laparoscopic surgery