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  • 1. Introduction
  • 2. Abdominal Exploration
  • 3. Mobilization of Greater Omentum
  • 4. Infrapyloric Mobilization
  • 5. Superpyloric Dissection
  • 6. Duodenal Transection
  • 7. Greater Curvature Mobilization
  • 8. Gastrectomy
  • 9. Billroth II Reconstruction
  • 10. Closure
  • 11. Debrief
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Distal Gastrectomy (Open)


John T. Mullen, MD, Andrea L. Merrill, MD
Massachusetts General Hospital

Procedure Outline

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