Prophylactic Total Gastrectomy for CDH1 Gene Mutation

1. Introduction

2. Incision and Access to the Abdomen

3. Abdominal Exploration

4. Entry into Lesser Sac and Division of Omentum

1. Divide Right Gastric

5. Infrapyloric Dissection

1. Divide Gastroepiploic Vessels

6. Suprapyloric Dissection

7. Duodenal Transection

8. Greater Curvature Dissection

1. Open Peritoneum
2. Divide Left Gastric Pedicle
3. Divide Short Gastrics and Left Gastroepiploics

9. Intra-abdominal Esophageal Dissection

1. Divide Anterior and Posterior Vagus Nerves

10. Esophageal Transection

1. Double-Check Z-Line

11. Purse-String Suture for Esophageal Opening

12. Jejunojejunostomy

1. Measure 60-cm Roux Limb

13. Esophagojejunostomy

1. Results from Pathology

14. Excision of Open End of Roux Limb

15. Inspection and Hemostasis

16. Closure

1. Close Defect in Diaphragm
2. Reapproximate Transverse Mesocolon to Roux Limb

17. Post-op Remarks