RESUMEN
BACKGROUND AND STUDY AIMS: Though endoscopic mucosal resection is successful for early gastric carcinoma, the indication for endoscopic mucosal resection appears to exclude larger early gastric carcinomas. We report here on our experience in resecting early gastric carcinoma using laparoscopy-guided partial resection of the stomach extracorporeally. PATIENTS AND METHODS: Seven patients with early gastric carcinoma were treated surgically under laparoscopic guidance. After an inspection of the abdominal cavity by laparoscope through an umbilical port, a gastrofiberscope was then inserted into the stomach perorally, and confirmation of the site of the carcinoma was provided by illuminating the interior gastric wall endoscopically. The gastric wall portion including the carcinoma was then exteriorized through a small upper midline incision, and resected. The gastrotomy was sutured extracorporeally, and then repositioned inside the abdomen. RESULTS: All the carcinomas were successfully resected extracorporeally, with cancer-free margins. Postoperative courses were uneventful, and the average period of hospitalization after the operation was ten days. CONCLUSIONS: This type of laparoscopy-guided partial resection of the stomach is expected to become more widely adopted as a treatment for early gastric carcinoma.
Asunto(s)
Adenocarcinoma/cirugía , Gastrectomía/métodos , Laparoscopía , Neoplasias Gástricas/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Mucosa Gástrica/cirugía , Humanos , Laparoscopios , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
We report two surgical treatments by laparoscopic techniques of a leiomyoma in the stomach, each for one patient. The patients, one a 59-year-old man and the other a 28-year-old woman, were found to have an asymptomatic submucosal tumor in the stomach in an annual medical screening. One tumor, 1.5 cm in maximum diameter, was located on the anterior wall of the gastric body and was excised extracorporeally by laparoscopy-guided surgery. The other was 1.9 cm in maximum diameter, on the anterior wall of the antrum, and was excised intracorporeally using only laparoscopic surgery. Their postoperative courses were uneventful. They drank clear liquid after the removal of a nasogastric tube on the first postoperative day and had a solid meal on the second postoperative day. They were discharged from the hospital on the seventh and eighth postoperative days.
Asunto(s)
Laparoscopía/métodos , Leiomioma/cirugía , Neoplasias Gástricas/cirugía , Adulto , Femenino , Humanos , Leiomioma/diagnóstico por imagen , Leiomioma/patología , Masculino , Persona de Mediana Edad , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/patología , UltrasonografíaRESUMEN
Endoscopic ultrasonography (EUS) has been recently developed as a new diagnostic technique for portal hypertension. However, its conventional water-filled balloon technique is not suitable for the evaluation of esophageal varices, because the vessel lumen is compressed by the inflated balloon. Particularly for small varices, the vessel tends to collapse and is difficult to display. A miniature ultrasonic probe for use via the forceps channel in EUS has been developed and is expected to overcome this difficulty. Here we report the efficacy of this new probe in patients with esophago-gastric varices. Instead of using a water-filled balloon for an acoustic window, we displayed the EUS findings from the new probe in direct contact with gastrointestinal wall by removing air from the lumen under vacuum. Both conventional endoscopy and the new EUS were performed on 3 patients with esophageal varices. The transforceps-channel ultrasonic probe visualized grade 1 varices in addition to the larger varices, confirming this technique to be a useful method for assessing of esophageal varices. Moreover, this method does not require a specially designed endoscope for EUS, rather it can be employed in combination with conventional endoscopy. We conclude that this new technique is a preferred diagnostic technique, and it should become more widely accepted for routine clinical applications.