Laparoscopic Transgastric Resection of Intraluminal Gastric Gist with Concurrent Mesh Repair of Large Sliding Hiatus Hernia: A Case Report

Christophe R. Berney

Department of Surgery, Bankstown-Lidcombe Hospital, University of New South Wales, Australia

^*Correspondance to: Christophe R. Berney 

 PDF  Full Text DOI: 10.25107/2474-1647.2156

Abstract

Gastrointestinal Stromal Tumours (GISTs) are rare and most commonly found in the stomach. Depending on their size and location, laparoscopy is the preferred technique as the tumour can be easily removed by simple wedge excision of the gastric wall. However, if the GIST is located in the posterior gastric wall or near the cardio-Oesophageal Junction (COJ) where complete excision might be particularly difficult to achieve, such lesion can still be safely managed laparoscopically through atailored transgastric approach, with excellent long-term results. We present the case of a 77-year-old female with a large (>5 cm) sliding hiatus hernia diagnosed with the presence of an associated gastric GIST, located close to the COJ, and that had migrated into the mediastinum. She underwent successful combined laparoscopic transgastric excision of the tumour with mesh repair of her hiatus hernia, and anterior partial fundoplication. The patient was discharged 3 days later on a soft diet and subsequently made a swift recovery with complete resolution of her pre-operative symptoms. Final histopathology report confirmed the diagnosis of low malignant potential well-circumscribed gastric GIST and margins were clear (R0). A surveillance gastroscopy and CT-scan at one-year post surgery were normal. She is at almost 2-yearspostoperative and remains asymptomatic. In this instance, an adapted surgical approach was necessary to facilitate safe and complete removal of the gastric GIST, following reduction of her large hiatus hernia. We believe that such proposed sequential approach can be safely performed with minimum risk, irrespective of the patient’s age.

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Cite the article

Berney CR. Laparoscopic Transgastric Resection of Intraluminal Gastric Gist with Concurrent Mesh Repair of Large Sliding Hiatus Hernia: A Case Report. Clin Surg. 2018; 3: 2156.