Friday, July 17, 2009

Laparoscopic Gastric GIST resection

This patient, during a routine EGD for epigastric discomfort, was found to have a small submucosal mass in the gastric antrum (you can see it on the above CT if you look closely). A subsequent endoscopic ultrasound suggested that there was some invasion of the muscle layer of the stomach as well. The surgery went well. A combination of endoscopic staplers and laparoscopic suturing closed the resultant gastrotomy. The patient went home on day #3. The final path confirmed a low grade GIST (gastrointestinal stromal tumor) with clean margins.

Laparoscopy for gastric stromal tumors is a reasonable alternative to the traditional open approach. Here's a link to a paper by some smart guys down in North Carolina on the topic. Best outcomes are seen when the tumor is small, has a low mitotic index (i.e. rate of growth), and when the surgical margins are clean. Check, check and check on my guy. He ought to do just fine.


radinc said...

I dunno, I always think you surgeons are getting too fancy with the laparoscopic tools.

I mean you have to take the thing out so you need to make a 5cm incision anyway. So why not make a 15 cm incision, get in there and get out in 20 minutes rather than dick around with laparoscopic toys for an hour or more.

The biggest risk in this relatively minimal surgery is sedation time, isn't it?

I remember when I was a med student and laparoscopy was getting hot a guy did a "lap-hand assisted" splenectomy. It took 3 hours and he had to make a 20cm incision to take the giant spleen out anyway. What if the thing ruptured that would have really been a huge fiasco.


nemsova said...

great post,buckeye,and nice job!

Jeffrey Parks MD FACS said...

Good questions radinc. Open gastric resections usually result in 7-10 day hospitalizations, signif post op pain. Minimally invasive surgery reduces pain, allows patients to return to life quicker. But these are difficult things to quantify. From a hard line cost perspective, much of minimally invasive surgery can be difficult to justify. Patient demand, referring doctor expectations also play a role...