gms | German Medical Science

Objectives: Benign gastric tumors, depending on location and size, may represent a potential challenge for endoscopic and surgical therapy. Partial gastric resection is usually indicated for tumors larger than 3cm, when endoscopic resection is not possible, resulting in unnecessary resection of considerable amount of healthy gastric tissue. Besides the crescent intraabdominal use of Single Port surgery for gastric resection, intragastric surgery with Single Port platform is rarely described.This study describes the aplication of this new intraluminal technique for resection of large intragastric masses.

Methods: A 61-year-old female patient with previous heartburn had endoscopic diagnosis of a submucosal 6cm diameter intragastric mass in gastric fundic region compatible with gastrointestinal stromal tumor. Preoperative biopsy showed no presence of malignacy, and the surgical treatment was indicated. Intraoperative endoscopy helped in retrating the mass and assuring free stapling margins. A 2.5 cm incision was made subxyphoid and allowed exteriorization of the gastric wall, and a SILS Port was introduced under direct view. Intragastric sleeve resection of the tumor was performed using consecutive charges of 60 mm stapling. The specimen was extracted through the single port without extraction bag. The gastrotomy was closed percutaneously with conventional single layer absorbable suture.

Results: The procedure time was 58 min. There were no intraoperative complications. Histopatologic examination confirmed a GIST diagnosis. Postoperative the patient underwent regular diet on the next day, and was dismissed on the 3^rd postoperative day. At 6th day follow-up the patient required drainage of a wound abscess that was posteriorly managed at ambulatorial basis. Hystopathology showed tumor free-margins.

Conclusion: The new concept of intragastric percutaneous Single Port partial gastrectomy (IGS) allows the resection of large intragastric benign tumors with free margins thus avoiding sacrifice of unnecessary healthy tissue. It can be indicated when the endoscopic resection is not possible and for large specimens requiring full-thickness therapy.