Laparoscopic treatment of gastric stromal tumors |
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Authors: | N Basso P Rosato A De Leo T Picconi P Trentino A Fantini G Silecchia |
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Institution: | (1) II Clinica Chirurgica, Policlinico Umberto I, Università ``La Sapienza', Viale del Policlinico 155, 00161 Rome, Italy, IT |
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Abstract: | Background: The laparoscopic resection of gastric stromal tumors (GST) is being performed with increased frequency.
Methods: Between November 1993 and October 1998, nine consecutive patients with benign and low-grade gastric stromal tumors underwent
laparoscopic resection using intraoperative endoscopy. For lesions located on the anterior wall (three cases), a direct approach
was utilized. Lesions located on the posterior wall were resected via a transgastric approach (four cases) or through a small
opening on the omentum or on the gastrocolic ligament (two cases). Excision of the lesions was performed manually by means
of electrocautery and scissors in eight cases; the gastric incisions were closed by manual running suture. An endoscopic stapler
device was used in one case only.
Results: All patients were successfully treated laparoscopically; there were no conversions to open surgery. Operative time ranged
from 75 to 120 min. There was one bleeding from the suture line of the gastric wall postoperatively that was treated conservatively.
The average postoperative hospital stay was 4 days (range, 2–6).
Conclusions: In light of the results reported in the literature and on the basis of the present work, it seems that laparoscopic resection
of GST should be considered as the treatment of choice. Wedge resection of anterior wall lesions is generally performed. The
treatment of posterior wall lesions is still controversial. In our opinion the direct approach should be reserved for lesions
located on the posterior wall of the body, which can be easily reached through the greater omentum, while the transgastric
approach should be preferred for lesions located on the fundus and antrum. Manual excision allows a tailored operation; hand-sewn
sutures are always feasible, and they are cheaper than stapled ones.
Received: 30 April 1999/Accepted: 7 October 1999/Online publication: 10 April 2000 |
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Keywords: | : Gastrointestinal stromal tumors — Laparoscopy — Leiomyoma — Schwannoma |
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