Gastrectomy

The opening of the abdomen is performed via a transverse upper abdominal laparotomy with upper median laparotomy, so-called “inverted T“.
Then, using diathermy, the subcutaneous tissue and subsequently the rectus musculature are transected along the linea alba.
The opened abdominal cavity is now explored to assess the location and extent of the tumor and thus the resectability after exclusion of distant metastases, especially on the peritoneum and liver. The tumor is located in the middle third of the stomach at the greater curvature.

After releasing pericholecystic adhesions, the lesser omentum is detached close to the liver from distal to proximal while sparing the hepatoduodenal ligament. The preparation then continues to the gastroesophageal junction. The abdominal esophagus is circumferentially exposed and looped.

Now follows the mobilization of the duodenum according to Kocher. In this process, the paraduodenal peritoneum is incised approximately 1 cm away from the lateral margin and the duodenum is elevated dorsally in a largely avascular plane from the retroperitoneum and the vena cava is exposed.

Start of the lymph node dissection at the hepatoduodenal ligament (LN group 12), during which the right gastric artery is transected close to its origin and the common hepatic artery is looped.