Laparoscopic total gastrectomy for an advanced gastric cancer associated with an upside down stomach : Report of a case Shuichi ISHIBASHI 1 , Takeshi MATSUBARA 1 , Noriyuki HIRAHARA 1 , Ryoji HYAKUDOMI 1 , Toshihiro TAKANASHI 1 , Yoshitsugu TAJIMA 1 1Department of Digestive and General Surgery, Shimane University Faculty of Medicine Keyword: upside down stomach , 腹腔鏡下胃切除 , 進行胃癌 pp.207-212
Published Date 2017/3/15
DOI https://doi.org/10.11477/mf.4426200386
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A 91-year-old female with complaints of anorexia and weight loss was referred to our hospital. An upper endoscopy detected a huge advanced gastric cancer at the upper part of the stomach. Abdominal CT scan showed an extramural invasion of the tumor and demonstrated an esophageal hiatal hernia with an upside down stomach. Although the patient was a very elderly woman with a performance status of grade 2, she underwent laparoscopic surgery. However, intraoperative peritoneal lavage cytology was positive, and the patient underwent a laparoscopic total gastrectomy with D1+ lymph node dissection, as a reduction surgery, together with hiatus hernia repair. We filled some pieces of gauze in the hernia sac for drawing the intrathoracic stomach into the abdominal cavity prior to performing a gastrectomy, which facilitated a successful laparoscopic gastrectomy. Inserting gauze in the hernia sac to draw the intrathoracic stomach into the abdominal cavity enabled us to handle a large gastric cancer associated with upside down stomach in laparoscopic surgery.

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