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Laparoscopic Gastrectomy and Transvaginal Specimen Extraction in a Morbidly Obese Patient with Gastric Cancer.

Sumer F, Kayaalp C, Karagul S - J Gastric Cancer (2016)

Bottom Line: Laparoscopic gastrectomy for cancer has some significant postoperative benefits over open surgery with similar oncologic outcomes.This procedure is more popular in the Far East countries where obesity is not a serious public health problem.In this case, we performed a fully laparoscopic subtotal gastrectomy with lymph node dissection and Roux-en-Y gastrojejunostomy with the specimen extracted through the vagina.

View Article: PubMed Central - PubMed

Affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.

ABSTRACT
Laparoscopic gastrectomy for cancer has some significant postoperative benefits over open surgery with similar oncologic outcomes. This procedure is more popular in the Far East countries where obesity is not a serious public health problem. In the Western countries, laparoscopic gastrectomy for cancer is not a common procedure, yet obesity is more common. Herein, we aimed to demonstrate the feasibility of laparoscopic gastrectomy for advanced gastric cancer in a morbidly obese patient. Additionally, we used natural orifice specimen extraction as an option to decrease wound-related complications, which are more prevalent in morbidly obese patients. In this case, we performed a fully laparoscopic subtotal gastrectomy with lymph node dissection and Roux-en-Y gastrojejunostomy with the specimen extracted through the vagina. To the best of our knowledge, this was the first report of a natural orifice surgery in a morbidly obese patient with gastric cancer.

No MeSH data available.


Related in: MedlinePlus

Transvaginal extraction of the stomach.
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Figure 1: Transvaginal extraction of the stomach.

Mentions: A 58-year-old female was admitted for abdominal pain and dyspepsia lasting one year. Despite her recent weight loss, she was still morbidly obese (body mass index 44.2 kg/m2). She also had diabetes and hypertension. Upper gastrointestinal endoscopy revealed an adenocarcinoma at the gastric antrum. Computed tomography indicated a 45 mm mass in the antrum with no metastatic distant focus. Her laboratory tests were unremarkable except for mild anemia (hemoglobin: 12.0 g/dl). After patient consent was obtained, we planned a fully laparoscopic gastrectomy with transvaginal specimen extraction. She was placed in the lithotomy position and five trocars were applied to the abdomen as described before.2 A xiphoidal 5 mm port for a Nathanson liver retractor, three 12 mm trocars (at the intersection of the transverse umbilical line and right/left midclavicular lines and at the midline 5 cm inferior to the umbilicus), and a working 5 mm trocar (right subcostal) were placed. A total omentectomy, subtotal gastrectomy, D2 lymph node dissection, and Roux-en-Y gastrojejunostomy were completed exclusively by laparoscopy. An additional suprapubic 5 mm trocar was placed for retraction of the upper uterus and better visualization of the vagina. The posterior fornix of the vagina was opened using laparoscopic vision and the specimen was extracted transvaginally through the posterior fornix (Fig. 1, 2; Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images.). The posterior fornix was closed with a running absorbable suture. Operating time and blood loss were 430 minutes and 50 ml, respectively. The postoperative course was uneventful with the exception of the use of two units of red cell packs due to intra-abdominal self-limited oozing. She was discharged on day five. Histopathological examination demonstrated a pT3N2M0 (American Joint Committee on Cancer 7th edition), 3.5 cm diameter adenocarcinoma. Twenty-two lymph nodes were retrieved with three metastatic locations along the greater curvature. She received adjuvant chemo-radiotherapy (six cycles of 5-flourouracil and folinic acid plus 45 Gy radiotherapy). She had no recurrence well after the 7.5-month follow-up.


Laparoscopic Gastrectomy and Transvaginal Specimen Extraction in a Morbidly Obese Patient with Gastric Cancer.

Sumer F, Kayaalp C, Karagul S - J Gastric Cancer (2016)

Transvaginal extraction of the stomach.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834621&req=5

Figure 1: Transvaginal extraction of the stomach.
Mentions: A 58-year-old female was admitted for abdominal pain and dyspepsia lasting one year. Despite her recent weight loss, she was still morbidly obese (body mass index 44.2 kg/m2). She also had diabetes and hypertension. Upper gastrointestinal endoscopy revealed an adenocarcinoma at the gastric antrum. Computed tomography indicated a 45 mm mass in the antrum with no metastatic distant focus. Her laboratory tests were unremarkable except for mild anemia (hemoglobin: 12.0 g/dl). After patient consent was obtained, we planned a fully laparoscopic gastrectomy with transvaginal specimen extraction. She was placed in the lithotomy position and five trocars were applied to the abdomen as described before.2 A xiphoidal 5 mm port for a Nathanson liver retractor, three 12 mm trocars (at the intersection of the transverse umbilical line and right/left midclavicular lines and at the midline 5 cm inferior to the umbilicus), and a working 5 mm trocar (right subcostal) were placed. A total omentectomy, subtotal gastrectomy, D2 lymph node dissection, and Roux-en-Y gastrojejunostomy were completed exclusively by laparoscopy. An additional suprapubic 5 mm trocar was placed for retraction of the upper uterus and better visualization of the vagina. The posterior fornix of the vagina was opened using laparoscopic vision and the specimen was extracted transvaginally through the posterior fornix (Fig. 1, 2; Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images.). The posterior fornix was closed with a running absorbable suture. Operating time and blood loss were 430 minutes and 50 ml, respectively. The postoperative course was uneventful with the exception of the use of two units of red cell packs due to intra-abdominal self-limited oozing. She was discharged on day five. Histopathological examination demonstrated a pT3N2M0 (American Joint Committee on Cancer 7th edition), 3.5 cm diameter adenocarcinoma. Twenty-two lymph nodes were retrieved with three metastatic locations along the greater curvature. She received adjuvant chemo-radiotherapy (six cycles of 5-flourouracil and folinic acid plus 45 Gy radiotherapy). She had no recurrence well after the 7.5-month follow-up.

Bottom Line: Laparoscopic gastrectomy for cancer has some significant postoperative benefits over open surgery with similar oncologic outcomes.This procedure is more popular in the Far East countries where obesity is not a serious public health problem.In this case, we performed a fully laparoscopic subtotal gastrectomy with lymph node dissection and Roux-en-Y gastrojejunostomy with the specimen extracted through the vagina.

View Article: PubMed Central - PubMed

Affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.

ABSTRACT
Laparoscopic gastrectomy for cancer has some significant postoperative benefits over open surgery with similar oncologic outcomes. This procedure is more popular in the Far East countries where obesity is not a serious public health problem. In the Western countries, laparoscopic gastrectomy for cancer is not a common procedure, yet obesity is more common. Herein, we aimed to demonstrate the feasibility of laparoscopic gastrectomy for advanced gastric cancer in a morbidly obese patient. Additionally, we used natural orifice specimen extraction as an option to decrease wound-related complications, which are more prevalent in morbidly obese patients. In this case, we performed a fully laparoscopic subtotal gastrectomy with lymph node dissection and Roux-en-Y gastrojejunostomy with the specimen extracted through the vagina. To the best of our knowledge, this was the first report of a natural orifice surgery in a morbidly obese patient with gastric cancer.

No MeSH data available.


Related in: MedlinePlus