Presenter: Diego Gallegos, MD
Authors: Diego Gallegos, MD; Pedro Mercado, MD; Roberto Vagni, MD; Juan Moldes, MD; Pablo Lobos, MD; Gaston Elmo, MD; Hospital Italiano de Buenos Aires
Hereditary diffuse gastric cancer (HDGC) is caused by an autosomal dominant mutation in CDH1. Endoscopic surveillance in these cases is often ineffective. We present the case of a teenager with this mutation and family history of HDGC in which we performed a prophylactic laparoscopic total gastrectomy.
Surgical technique requires omentectomy and division of the short gastric vessels. Both the pyloric and the left gastric artery have to be properly ligated and the duodenum is transected with stapler. A Roux-en-Y reconstruction is then performed and the ascended jejunal segment is connected to the distal esophagus with a circular stapler.
An upper GI contrast study at postoperative day 4 showed a leak at the lateral side of the esophageal anastomosis that was managed conservatively. Patient was discharged on the 10th day.
The laparoscopic approach was a safe minimally invasive way to complete a prophylactic total gastrectomy in this patient