Operative Steps Gastrectomy

Operative Steps Gastrectomy

Indications of gastrectomy

Benign

1.Erosive gastritis/Atrophic gastritis (In rare  conditions)

2. Gastric necrosis (Gastric Volvulus, HIatus Hernia)

3.Corrosive injuries with necrosis of stomach

4. Diffuse polyposis

Malignant

  1. Adenocarcinoma of proximal stomach
  2. Lymphoma
  3. Large GIST

Preop Preparation

1.Gastric Lavage

2. Nutritional and metabolic build up

3.Correct electrolytes

 

Steps of Radical Gastrectomy

Incision

  1. Biltaeral subcostal or midline incison  and Left thoracoabdominal from 7th rib in proximal tumors

Retraction

Omni retractor or Thomson retractor used to elevate the rib cage. There should be proper exposure of stomach, leeser omentum, greater omentum and duodenum.

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3. Exploration of Abdomen

Abdominal cavity  is explored for metastasis especially liver, pouch of douglous, ovaries, base of mesentary, mesocolon, pelvis.

Note the site of tumor, extent and depth of the malignancy. Is there involvemnt of the adjacent organs?

4. Mobilization

Bring down the hepatic flexure of colon and do a wide Kocher's maneuver

There is a plane between the greater omentum and transverse mesocolon which has to be developed from right to left

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