Gastric wedge resection

Published on 09/04/2015 by admin

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Last modified 09/04/2015

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CHAPTER 6 Gastric wedge resection

Step 2. Preoperative considerations

Patient preparation

Gastric tumors appropriate for wedge resection are generally identified either endoscopically or radiographically during workup of nonspecific upper abdominal symptoms, gastroesophageal reflux, obstruction/early satiety, pain, or gastrointestinal hemorrhage.

On upper endoscopy, tumors generally amenable to a laparoscopic wedge resection are submucosal lesions with an intact mucosal layer. Those that appear mucosal-based or ulcerated may not be appropriate for a wedge resection based on histologic diagnosis, and the planned approach should be reevaluated.

On radiographic imaging, such as computed tomography (CT), tumors may appear as well-encapsulated or infiltrative lesions within the gastric wall or as exophytic lesions protruding intra- or extraluminally (Figure 6-1). Presence of extensive lymphadenopathy may suggest either lymphoma or gastric adenocarcinoma, necessitating a change in treatment.

Additional imaging and laboratory studies for cancer staging may be ordered based on confirmed or suspected diagnosis.

Endoscopic or image-guided fine-needle aspiration or core needle biopsy is indicated if the differential diagnosis would significantly change management. For instance, lymphoma would be treated with nonoperative, medical management, whereas gastric adenocarcinoma would require a more extensive gastric resection plus lymphadenectomy. Although resection for a gastric adenocarcinoma may also be performed laparoscopically, the resection involves removing more gastric tissue, and the procedure should be planned appropriately preoperatively.

Some surgeons tattoo the lesion preoperatively, to assist in localization.

Anesthesia

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