Page 3 - WJOLS - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Laparoscopic Management of Polypoidal Lesions of the

Stomach

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Shantata J Kudchadkar , Pranav Mandovra , Roy Patankar
AbstrAct
Aim: Our aim was to study the feasibility of a laparoscopic approach in the management of polypoidal lesions of the stomach.
Materials and methods: We present a review of laparoscopic management in polypoidal lesions of the stomach in four patients. All patients
underwent routine preoperative workup along with esophagogastroduodenoscopy, biopsy, and contrast-enhanced computed tomography
(CECT) scan of the abdomen. Three patients underwent wedge resection of the stomach using a laparoscopic linear stapler and one underwent
laparoscopic anterior wall gastrotomy with polypectomy.
Results: Of four patients, three were males and one was female in the age range of 40–60 years. Presenting symptoms ranged from generalized
weakness, episodes of intermittent vomiting, dyspepsia, and weight loss. Common sites involved were fundus and body of the stomach in three
patients and antrum in one patient. Surgery via a laparoscopic approach was the mainstay of the treatment. Final histopathology revealed
gastrointestinal stromal tumor (GIST) in three patients and adenomatous polyp in one patient. Patients diagnosed with GIST were further referred
to a medical oncologist for mutational analysis and adjuvant therapy. All patients are on regular follow-up postoperatively.
Conclusion: Asymptomatic, polypoidal lesions of the stomach can present with occult GI bleeding or gastric outlet obstruction. The main point
to be taken into consideration in treating large-sized polyps is the selection of management option (endoscopic vs laparoscopic). Laparoscopic
excision is a better alternative to treat giant polyps considering the size, location, and potential for malignancy, as opposed to an endoscopic
approach.
Keywords: Adenomatous polyp, Gastric outlet obstruction, Gastric polyp, Gastrointestinal stromal tumor, Hyperplastic polyp, Laparoscopic
anterior wall gastrotomy.
World Journal of Laparoscopic Surgery (2018): 10.5005/jp-journals-10033-1346

IntroductIon 1–3 Department of Minimal Access and GI Surgery, Zen Multispeciality
Polypoidal lesions of the stomach are broadly defined as Hospital, Mumbai, Maharashtra, India
locally elevated lesions protruding into the gastric lumen, a Corresponding Author: Shantata J Kudchadkar, Department of Minimal
heterogeneous group of epithelial and subepithelial lesions that Access and GI Surgery, Zen Multispeciality Hospital, Mumbai, Maharashtra,
vary in histology, neoplastic potential, and management, usually India, Phone: +44 7587437988, e-mail: shantatak@gmail.com
small and asymptomatic (>90%). Symptoms produced by polypoidal How to cite this article: Kudchadkar SJ, Mandovra P, et al. Laparoscopic

lesions are vague and nonexistent until complications arise such Management of Polypoidal Lesions of the Stomach. World J Lap Surg
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as bleeding, anemia, obstruction, or abdominal pain. They are 2018;11(3):111–114.
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discovered incidentally on endoscopic examination in about 2–5%. Source of support: Nil

The frequency of polyps is increasing with the widespread use of Conflict of interest: None

endoscopy for diagnosis and treatment.
Epithelial polyps (hyperplastic, fundic gland, and adenomatous)
are the classic gastric polyps, but clusters of endocrine cells stomach using a laparoscopic linear stapler and one underwent
(carcinoids), infiltrates (xanthomasand lymphoid proliferations), or laparoscopic anterior wall gastrotomy with polypectomy under
mesenchymal proliferations [GIST, leiomyoma, and inflammatory general anesthesia. Workup and management of all four patients
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fibroid polyps (IFPs)] may create a mucosal protrusion. are depicted in Table 1.
Symptomatology depends upon the size, multiplicity, location,
and character of the lesions. Meticulous endoscopic examination, surgIcAl technIque
accurate biopsy, histopathologic evaluation, and periodic follow-up Port positions and basic steps:
examinations are critical.
Laparoscopic wedge resection of the stomach using linear
staplers (three patients):
MAterIAls And Methods • Ports: 10 mm umbilicus (camera), 12 mm (working) left mid-
We present a review of laparoscopic management of four cases clavicular, two 5 mm in both anterior axillary lines (working and
of polypoidal lesions of the stomach who presented in our center for traction). Pneumoperitoneum created using open insertion
from December 2017 to December 2018. All patients underwent technique and pressure maintained at 12 mm Hg.
routine preoperative workup along with upper GI endoscopy and • After identifying lesser sac and greater curvature, short gastric
a CECT scan. Three patients underwent wedge resection of the vessels were divided with harmonic. Intraluminal tumor

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