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RESECTION OF THE POSTERIOR GASTRIC WALL: ANOTHER STRATEGY AGAINST GIST WITH ENDOLUMINAL GROWTH

Gastrointestinal stromal tumors (GIST) occur most frequently at the gastric level. Surgical resection is the mainstay of treatment and can usually be performed using laparoscopic approaches (1). The resection strategy must be adjusted to each case, the selection of location, size and growth pattern of the tumor (2).

We present the case of a 78-year-old female patient who, after going to the Emergency Department due to symptoms of upper gastrointestinal bleeding, showed a 5 cm heterogeneous tumor depending on the muscular layer itself in a posterior gastric wall, endoluminal growth, and without objectifying others injuries in the study of extension. A wide posterior resection of the gastric posterior wall and primary closure with a barbed suture was performed laparoscopically. The postoperative evolution was satisfactory. The histopathological study shows low-risk GIST (5 mitosis / 50 CGA) with free margins; during follow-up, no recurrence was observed. Simple laparoscopic resection of gastric GIST tumors seems to be a useful strategy in terms of oncological safety, reducing excessive resection of tumor-free tissue and increasing gastric remnant.

Laparoscopic resection of the gastric posterior wall and primary closure.
Gist resection requiring large loss of gastric tissue
Tumor size greater than 5 cm (relative).
Reverse Trendelenburg position. Surgeon in-between patient´s legs.
Upper endoscopy. Endoscopic ultrasound. CT.
- Lesser sac. - GE junction
Advantages: Less loss of gastric capacity. Less bleeding. Control under direct vision of the GE juction. Cheaper surgery. Disadvantages: contamination of the surgical field.
Risks: leak.
The authors has no conflicts of interest to declare.
The patient in this video have given written informed consent to the publication of their case details
1. Kawamura H, Shibasaki S, Yoshida T, Homma S, Takahashi M, Taketomi A. Strategy of Laparoscopic Partial Resection for Gastric Gastrointestinal Stromal Tumors According to the Growth Pattern. Surg Laparosc Endosc Percutan Tech. 2015 Dec;25(6):e175-9. 2. Mazer L, Worth P, Visser B. Minimally invasive options for gastrointestinal stromal tumors of the stomach. Surg Endosc. 2020 Mar 27. [Epub ahead of print]

Review RESECTION OF THE POSTERIOR GASTRIC WALL: ANOTHER STRATEGY AGAINST GIST WITH ENDOLUMINAL GROWTH.

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