Transgastric single-incision laparoscopic resection for a recurrent gastric adenoma at the prepyloric antrum: A case report.

Abstract

Introduction: Endoscopic resection is suitable for most benign gastric or early stage cancerous polyps. Laparoscopic local resection is performed only for gastric polyps that are difficult to treat with endoscopic resection, such as recurrent or large polyps. However, when polyps are located in difficult regions, such as the gastric cardia and prepyloric antrum, wedge resection may damage the sphincter around the cardia or pylorus, resulting in postoperative deformity or stenosis.

Presentation of case: A 66-year-old gentleman found a 2.5 cm recurrent adenoma at pre-pyloric antrum when he repeated a esophagogastoscopy 1 year after a 2 cm polyp removed by endoscopic mucosal resection (EMR) at the same site. Owing to submucosal fibrosis, neither EMR nor endoscopic submucosal dissection is considered suitable for recurrent adenoma because of the increased risk of perforation. Pyloric stenosis or deformity was expected with traditional laparoscopic wedge resection for such a lesion located at the pre-pyloric antrum. Instead, we successfully performed a transgastric single-incision laparoscopic en bloc resection of the adenoma. Precise dissection was performed during surgery. The patient's postoperative recovery was uneventful. A repeated esophagogasroscopy one year later showed no recurrence.

Discussion: Transgastric single-incision laparoscopic resection for recurrent gastric mucosal lesions after previous endoscopic resection is technically feasible and safe.

Conclusion: This procedure can be an alternative choice for local resection of recurrent benign gastric mucosal lesions, especially for those located in special regions such as the prepyloric antrum or gastric cardia.