Total Gastrectomy

Question 1

Surgical Anatomy & Pathology

Answer 1

. The lesser omentum is connected to the lesser curvature of the stomach & extends to the posterior surface of the liver to hold the stomach in place
. The gastrophrenic ligament extends from the diaphragm to the cardia of the stomach to also help keep the stomach in normal anatomic position
. The inferior border of stomach is the greater curvature
. Arterial blood supply: Left gastric artery: branches of the celiac artery; branches of the splenic artery; branches of the left gastroepiploic; one branch of the left gastric artery; gastroduodenal artery
. Gastrectomy performed due to cancer or perforating bleeding ulcer that is unresponsive to conservative treatment

Question 2

Preoperative Diagnostic Tests & Procedures:

Answer 2

table 14-5

Question 3

Equipment & Instruments Unique to Procedure:

Answer 3

. Upper arm or Bookwalter self-retaining abdominal retractor
. Headlamp
. Laparotomy instrument set
. Long instruments
. Gastric or bowel resection instrument set
. Hemoclip appliers w/ ligating clips (open several each)
. Staplers or surgeon’s choice

Question 4

Supplies Unique to Procedure:

Answer 4

. #10 knife blades X3
. 18’’ Umbilical Tape
. Chest tubes & drainage unit if thorax-abdominal approach

Question 5

Preoperative Preparation

Question 6

Practical Considerations

Question 7

Surgical Procedure