Open surgical gastrectomy

Anatomy Perioperative management Technique Complications Evidence Total Video Medical Equipment

Content

Laparotomy
Preparation of the Hiatus and Looping of the Esophagus
Opening of the Omental Bursa
Mobilization according to Kocher
Transection of the Gastrosplenic Ligament
Resection of the Duodenum
Transection of the left gastric artery
Resection of the Stomach
Single Knot of the Counterpressure Plate
Lymphadenectomy D2
Preparation of the Roux-Y Loop
Retrocolic Elevation of the Efferent Loop
Esophagojejunal Anastomosis
Checking the Anastomosis/Leakage Control
Footpoint Anastomosis
Fixation in the Mesocolon defect/ Closure of the Mesenteric defect
Catheter Jejunostomy
Drains; Abdominal Wall Closure

Authors

Prof. Dr. med. Martin Kreis

Charite Berlin

Date

date of update: 18.09.2022

Laparotomy

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Opening of the abdominal cavity via a median upper abdominal laparotomy with left circumcision of the navel. After inserting a protective sheet, an abdominal wall retraction system, in the case shown a cable hook system plus Mercedes retractor, is installed.
Preparation of the Hiatus and Looping of the Esophagus

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After assessment and palpation of the liver (both not shown), the left liver lobe is mobilized and the lesser omentum is transected near the liver. Then the esophageal hiatus is opened and the esophagus is looped.
Opening of the Omental Bursa

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Detachment of the greater omentum from the transverse colon by incision of the gastrocolic ligament, then also releasing adhesions between the posterior wall of the stomach and the pancreas.
Mobilization according to Kocher

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The peritoneum is incised at the lateral edge of the duodenum, and it is freed from its retroperitoneal connections along with the head of the pancreas. Mobilization according to Kocher
Transection of the Gastrosplenic Ligament

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Next, the short gastric vessels, which run in the gastrosplenic ligament, are transected between Overholt clamps.