J Gastric Cancer.  2011 Jun;11(2):131-134.

Laparoscopic Gastric Wedge Resection and Prophylactic Antireflux Surgery for a Submucosal Tumor of Gastroesophageal Junction

• Lee JS
• Kim JJ
• Park SM

Abstract

A laparoscopic wedge resection for a submucosal tumor, which is close to the gastroesophageal junction, is technically challenging. This can be a dilemma to both patients and surgeons when the tumor margin involves the gastroesophageal junction because a wedge resection in this situation might result in a deformity of the gastroesophageal junction or an injury to the lower esophageal sphincter, which ultimately results in lifelong gastroesophageal reflux disease. The patient was a 42 year-old male, whose preoperative endoscopic ultrasonographic finding did not rule out a gastrointestinal stromal tumor. He underwent a laparoscopic gastric wedge resection and prophylactic anterior partial fundoplication (Dor) and was discharged from hospital on the fifth postoperative day without any complications. There were no symptoms of reflux 5 months after surgery. A laparoscopic wedge resection and prophylactic anti-reflux surgery might be a good surgical option for a submucosal tumor at the gastroesophageal junction.

Keyword

Submucosal tumor; Esophagogastric junction; Laparoscopic wedge resection; Antireflux surgery

MeSH Terms

Congenital Abnormalities
Esophageal Sphincter, Lower
Esophagogastric Junction
Fundoplication
Gastroesophageal Reflux
Gastrointestinal Stromal Tumors
Humans
Male

Figure

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  Fig. 1 The findings of preoperative study of the patient with a submucosal tumor of gastoresophageal junction. (A) Endoscopic finding showed 2.5 cm sized submucosal tumor involving the Z-line. (B) Endoscopic ultrasonographic finding showed hypoechoic submucosal mass originating from muscle layer. (C) Computed tomographic finding showed homogeneous mass at gastric cardia.

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  Fig. 2 Intraoperative view. (A) After careful division of lesser omentum from gastric cardia, 2.5 cm sized mass was identified at anterior and greater curvature side of cardia. (B) After wedge resection, about 2/3 of the circumference of the esophagus was detatched from the stomach with a large gastrotomy incision on the upper stomach. (C) New gastroesophageal junction was formed by intracorporeal 2-layerd interrupted and continuous sutures. (D) An anterior partial wrap was applied to the anterior wall of the abdominal esophagus.

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  Fig. 3 Findings of upper gastrointestinal series on the 1st postoperative day. A small indentation which was formed by anterior partial wrap was shown at gastroesophageal junction.

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