Distal Gastrectomy (Open)
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Procedure Outline
- Patient is positioned supine on operating table
- Anesthesia and antibiotic administration (usually a cephalosporin)
- Upper midline incision (xiphoid process to below umbilicus)
- Division of falciform ligament
- Abdominal exploration (for extent of locoregional disease and distant metastases)
- Special attn: peritoneal surfaces and liver
- Evaluation of remote lymph nodes for metastases
- Mobilization of the greater curvature with omentectomy and division of the left gastroepiploic artery
- Infrapyloric mobilization with ligation of the right gastroepiploic artery and vein as it enters the gastrocolic trunk
- Suprapyloric mobilization with ligation of the right gastric artery
- Duodenal transection
- Lymphadenectomy with dissection of the porta hepatis, common hepatic artery, left gastric artery, celiac axis, and splenic artery and ligation of left gastric artery
- Gastric transection
- Reconstruction by Billroth 2 or loop of Roux-en-Y gastrojejunostomy