Vagotomy with Antrectomy or any Distal Gastrectomy |
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Fig. 6.3 Steps in laparoscopic gastrectomy
The technique for hemigastrectomy is the same as for antrectomy or distal gastrectomy. An antrectomy can be combined with a bilateral truncal vagotomy in the treatment of gastric outlet obstruction. Technically the procedure is the same as for open surgery.
The various steps are as follows (Fig. 6.3):
Mobilization of the stomach’s greater curvature by opening the gastrocolic ligament
Dissection around the duodenum
Division of the lesser omentum and the right gastric artery
Transection of the duodenum
Reconstruction by a Biliroth II gastrojejunostomy
Vagotomy with Antrectomy or any Distal Gastrectomy
Port Placement
Port placement is slightly different from other upper GI operations. The laparoscope should be able to conveniently access both the hiatus, in the case of a bilateral truncal vagotomy, and the greater curvature of the stomach, especially if the stomach is distended as in gastric outlet obstruction. It should therefore be inserted at the umbilicus. Placement for this and the remaining ports are depicted in Fig. 6.4. Before starting the operation it is important to insert a nasogastric tube to decompress the stomach, thus avoiding any injury to the stomach upon insertion of the Veress needle.