[Transgastric laparo-endoscopic approach for difficult access lesions. Experimental mode].

BACKGROUND: Gastric neoplasms can be treated by laparoscopy in a safe and efficient way. Some lesions are not accessible to laparoscopic surgery due to their location. A transgastric approach is proposed as an alternative.

OBJECTIVE: Show the results with the application of an endoscopic laparotomy in an animal model that maintains functional anatomy, to resect the posterior gastric neoplasms of the stomach wall, close to the cardia and pre-pyloric region.

METHODS: The laparo-endoscopic technique for resection of gastric neoplasms located in the posterior wall was developed in twelve pigs at the Hospital General Gea González from May to December 2011.

TECHNIQUE: An endoscopy was performed to establish the site of insertion of intragastric trocars. Three gastrotomies were made in the anterior wall; under endoscopic and laparoscopic vision the trocars were inserted. The stomach was insufflated with CO2. The lesion was resected maintaining a 20 mm circumferencial margin. The gastrotomies were sutured. The statistic analysis was made with t Student and exact Fisher tests.

RESULTS: One-hundred percent of resections were achieved in an average time of 102.33 minutes (± 4.50). Two complications and no transoperatory deceases occurred.

DISCUSSION: The technique we describe allows an appropriate approach to gastric lesions located in the posterior wall, those near to the esophagogastric juntion and the prepiloric region, due to the excellent exposure managed by working inside the stomach with a laparoscopic vision and the two intragastric movile ports.

CONCLUSIONS: The laparoscopic transgastric approach is feasible and safe for the resection of gastric neoplasms located in the posterior wall, those close to the esophago-gastric junction, and the pre-pyloric region.