Med J Bakirkoy. 2020; 16(4): 379-384 | DOI: 10.5222/BMJ.2020.97759

Endoscopy Assisted Laparoscopic Resection for Gastric Submucosal Tumors Located Within 5cm From The Esophagogastric Junction; Combined Surgery at Difficult Localization

Erol Piskin, Osman Aydin, Yigit Mehmet Ozgun, Muhammet Kadri Colakoglu, Volkan Oter, Tahsin Dalgic, Erdal Bostanci
Depatmenet of Gastroenterological Surgery, Ankara City Hospital, Health of Science University, Ankara, Turkey

Objective: Removal of the lesion with safe surgical margins is often sufficient including GISTs. Endoscopic resections can become challenging or impossible even if the tumor was located near esophagogastric junction. Performing gastrectomy for these mostly benign lesions will also be a rather brutal treatment method in most cases.Therefore, alternative minimal invasive resection techniques and their reliability should be evaluated.
The aim of this study is to evaluate the efficacy and safety of endoscopy-assisted laparoscopic transgastric resection method in proximally located submucosal tumors.
Materials and methods: Transgastric combined endoscopic and laparoscopic surgery (CELS) with intragastric port was performed in one patient and Transgastric CELS with gastrotomy was performed in six patients who had tumor located near esophagogastric junction at XXX Hospital between February 2019 and February 2020.
Results: The patients were included 3 men and 4 women with and average age of 45.8 years (range 25-70). In five of the cases, four ports and nathanson retractor were used for liver retraction. While three ports were used in one patient, the stomach was suspended with traction suture. In one patient, 5 ports were used. The average operation time was 88 minutes (range 59-140 min). While gastrostomy line was closed with linear stapler in two patients, laparoscopic hand sewing method was used in the remaining patients. No patient had intraoperative complications.
Conclusion:
We strongly suggest that the laparoscopic transgastric resection approach for submucosal tumors close to the gastroesophageal junction, is a feasible and safe method, when used in combination with endoscopy.

Keywords: Esophagogastric Junction, Gastric Submucosal Tumors, Transgastric combined endoscopic and laparoscopic surgery.

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Özofagogastrik Bileþkeye 5cm Yakýnlýkta Yerleþen Mide Submukozal Tümörlerde Endoskopi Destekli Laparoskopik Rezeksiyon; Zor Lokalizasyonda Kombine Cerrahi

Erol Piskin, Osman Aydin, Yigit Mehmet Ozgun, Muhammet Kadri Colakoglu, Volkan Oter, Tahsin Dalgic, Erdal Bostanci
Saðlýk Bilimleri Üniversitesi Týp Fakültesi, Gastroenteroloji Cerrahisi Bilim Dalý, Ankara

Amaç: Submukozal Tumorlerde güvenli cerrahi sýnýrlar ile lezyonun çýkarýlmasý genellikle GIST'ler dahil olmak üzere yeterlidir. Endoskopik rezeksiyonlar, tümör özofagogastrik bileþkenin yakýnýnda bulunduðunda zor veya imkansýz hale gelebilir. Çoðunlukla iyi huylu bu lezyonlar için gastrektomi yapmak gereðinden fazla bir tedavi yöntemi olacaktýr, bu nedenle alternatif minimal invaziv rezeksiyon teknikleri ve bunlarýn güvenilirliði deðerlendirilmelidir.
Bu çalýþmanýn amacý, proksimal yerleþimli submukozal tümörlerde endoskopi yardýmlý laparoskopik transgastrik rezeksiyon yönteminin etkinliðini ve güvenliðini deðerlendirmektir.
Gereç ve yöntem: Þubat 2019 - Þubat 2020 tarihleri arasýnda XXX Hastanesi'nde özofagogastrik bileþke yakýnýnda submukozal tümörü olan hastalardan 1’ine intragastrik port ile transgastrik kombine endoskopik ve laparoskopik cerrahi (CELS), diðer 6 hastaya gastrotomi ile Transgastrik CELS uygulandý.
Bulgular: Yaþ ortalamasý 45,8 yýl (25-70 aralýðýnda) olan 3 erkek ve 4 kadýn hasta çalýþmaya dahil edildi. Vakalarýn beþinde, karaciðer retraksiyonu için dört port ve nathanson retraktörü kullanýldý. Bir hastada üç port kullanýldý ve mide traksiyon sütürü ile askýya alýndý. Bir hastada 5 port kullanýldý. Ortalama operasyon süresi 88 dakika (daðýlým 59-140 dakika) idi. Ýki hastada gastrostomi hattý lineer stapler ile kapatýlýrken, kalan hastalarda laparoskopik olarak sütütrasyon saðlandý. Hiçbir hastada intraoperatif komplikasyon görülmedi.
Sonuç: Gastroözofageal bileþkeye yakýn submukozal tümörler için laparoskopik transgastrik rezeksiyon yaklaþýmýnýn endoskopi ile birlikte kullanýldýðýnda uygulanabilir ve güvenli bir yöntem olduðu kanaatindeyiz.

Anahtar Kelimeler: Özofagogastrik Bileþke, Mide Submukozal Tümörler, Transgastrik kombine endoskopik ve laparoskopik cerrahi.

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