A Case of Laparoscopic Intragastric Surgery for a Gastric Submucosal Tumor after Fundoplication

Abstract

A 76-year-old woman underwent laparoscopic fundoplication and hiatal hernia repair in our hospital five years previously. During that procedure, a submucosal tumor was identified on the anterior wall of the upper gastric body, but due to 10 mm in diameter, it was decided to observe its progress. She had follow-up appointments at another hospital, but due to an increase in tumor size, she was referred to our hospital. Over the five-year period, the tumor increased from 10 mm to 30 mm in diameter, leading to the decision to perform resection. Because of the influence of the previous surgery, it was considered difficult to resect full-layer resection by laparoscopic and endoscopic cooperative surgery (LECS), and intragastric surgery was selected. The tumor could be resected without compromising the function of the cardia without excess or deficiency. Postoperatively, the patient developed surgical site infection (SSI), but was discharged from the hospital on the 11th hospital day. She has been alive 6 months postoperatively without recurrence. Compared to LECS, intragastric surgery has a higher incidence of complications from surgical procedures and tends to cause more SSIs, so we need to devise surgical procedures. Intragastric surgery is deemed highly effective, particularly in cases where external access to the gastric wall is challenging and full-thickness resection is difficult for various reasons.