Laparoscopic treatment of gastric stromal tumors

Background: The laparoscopic resection of gastric stromal tumors (GST) is b eing performed with increased frequency. Methods: Between November 1993 and October 1998, nine consecutive patients with benign and low-grade gastric stromal tumors underwent laparoscopic resection using intraoperative endosc opy. For lesions located on the anterior wall (three cases), a direct appro ach was utilized. Lesions located on the posterior wall were resected via a transgastric approach (four cases) or through a small opening on the oment um or on the gastrocolic ligament (two cases). Excision of the lesions was performed manually by means of electrocautery and scissors in eight cases; the gastric incisions were closed by manual running suture. An endoscopic s tapler device was used in one case only. Results: All patients were successfully treated laparoscopically; there wer e no conversions to open surgery. Operative time ranged from 75 to 120 min. There was one bleeding from the suture line of the gastric wall postoperat ively that was treated conservatively. The average postoperative hospital s tay was 4 days (range, 2-6). Conclusions: In light of the results reported in the literature and on the basis of the present work, it seems that laparoscopic resection of GST shou ld be considered as the treatment of choice. Wedge resection of anterior wa ll lesions is generally performed. The treatment of posterior wall lesions is still controversial. In our opinion the direct approach should be reserv ed for lesions located on the posterior wall of the body, which can be easi ly reached through the greater omentum, while the transgastric approach sho uld be preferred for lesions located on the fundus and antrum. Manual excis ion allows a tailored operation; hand-sewn sutures are always feasible, and they are cheaper than stapled ones.