GIST - distal gastrectomy according to Roux-Y

The endoscopic examination reveals a submucosal tumor of the gastric wall obstructing the gastric outlet.

The operation begins with a laparoscopic exploration of the abdomen to exclude peritoneal and liver metastases. In the course of this, an opportunistic cholecystectomy is performed independently of the tumor operation (not shown). After fenestration of the gastrocolic ligament with opening of the omental bursa, the posterior wall of the stomach becomes visible. The prepyloric tumor appears to be well resectable. Endosonographically, this tumor corresponds to an echo-heterogeneous 26 × 12 mm mass within the gastric wall.

Due to the location of the tumor directly prepyloric, an atypical resection of the tumor is not possible, and there is an indication for distal gastrectomy. Therefore, conversion to an open procedure using a right-biased transverse upper abdominal laparotomy. After opening the abdominal cavity, the findings are inspected and palpated again.

After mobilization of the descending part of the duodenum, the dissection of the proximal resection margin at the lesser and greater curvature is performed first. The preparation of the stomach can be done close to the stomach wall, as neither large safety margins nor lymph node dissection are necessary.

Continue the dissection distally step by step at least 2 cm beyond the pylorus, severing the right gastric artery at the lesser curvature and the right gastroepiploic artery and vein near the gastric wall at the greater curvature. Once the duodenum is circumferentially mobilized postpylorically, it is transected with the stapling device.

Oversewing the staple line of the duodenal stump with seromuscular interrupted sutures.