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
- Adenocarcinoma of proximal stomach
- Lymphoma
- Large GIST
Preop Preparation
1.Gastric Lavage
2. Nutritional and metabolic build up
3.Correct electrolytes
Steps of Radical Gastrectomy
Incision
- 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.
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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