Page 6 - WJOLS - World Journal of Laparoscopic Surgery

Laparoscopic Management of Polypoidal Lesions of the Stomach
and resected with adequate margins by firing linear staplers at Surgical resection is the mainstay for nonmetastatic tumors,
pedicle base in the body of the stomach. Reinforcement vicryl most commonly in the form of a wedge resection. Treatment of
sutures placed around the staple line. GIST requires a multidisciplinary team approach consisting of
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• Ryle's tube (RT) position was confirmed and gastrotomy pathologist, radiologist, surgeon, and oncologist.
closed in two layers with continuous ethibond and silk sutures. Basic treatment of polypoidal lesions of the stomach is
Specimen was delivered under direct vision by increasing left excision, either endoscopic or surgical. Surgical treatment is
12 mm port. recommended in polyps greater than 2 cm, sessile polyps, and
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failure of endoscopic treatment. Incidence of gastric outlet
In all cases, hemostasis was confirmed at the end of the obstruction due to polyps is unknown, with only few cases
procedure, and the 10 and 12 mm ports closed under direct vision.
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reported in the literature.
results
conclusIon
Of the four patients, three were males and one was female in the
age group of 40–60 years. Presenting symptoms in all ranged Though rare in occurrence and majority being asymptomatic,
from generalised weakness, episodes of intermittent vomiting, polypoidal lesions of the stomach can present with anemia, occult
dyspepsia, and weight loss. Common sites involved were fundus and GI bleeding, or gastric outlet obstruction. We presented a review of
the body of the stomach in three patients and antrum in one patient. four cases of polypoidal lesions of the stomach with special attention
Table 1 gives the details regarding esophagogastroduodeno- toward their management via a laparoscopic approach. The main
scopy (OGD scopy), biopsy, CT scan findings, surgical procedure point to be taken into consideration in treating large-sized polyps is
undertaken, and final histopathological diagnosis in our four the selection of management option (endoscopic or laparoscopic).
patients. Postoperatively, our patients received IV antibiotic and PPI Because of their malignant potential, histopathological evaluation
for 5 days. All had good postop recovery with uneventful course is mandatory.
and were discharged on soft diet by day 8. The main disadvantage of endoscopic methods is the risk of
Histopathologic slides were evaluated by the same pathologist incomplete tumor resection. Also, the procedure becomes difficult
and patients are on regular follow-up with yearly check upper GI with an increase in polyp diameter and complications such as
endoscopy. Patients with GIST were referred to a medical oncologist bleeding and perforationmay occur.
for mutational study and adjuvant therapy. So, it seems that laparoscopic excision is a better alternative to
treat such polyps, considering the size, location, and potential for
malignancy, as opposed to an endoscopic approach.
dIscussIon
Giant polypoidal lesions of the stomach are uncommon, and
detection of polyps at upper gastrointestinal endoscopy is usually references
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114 World Journal of Laparoscopic Surgery, Volume 11 Issue 3 (September–December 2018)