COMPREHENSIVE ATLAS OF SURGICAL TECHNIQUES
The approach is through a median supraumbilical or left subcostal incision.
The tumor is represented on the smaller curvature of the stomach.
The greater omentum is elevated opening the omental bursa from the pylorus to the upper third of the stomach.
The duodenum is stapled.
The smaller omentum is opened along the liver to its upper third too and will be resected with the distal stomach. The stomach is transversally stapled.
The D2 lymphatic dissection is carried out freeing the middle, vertical course of the hepatic arteries and the origin of the celiac axis.
The gastroenteroanastomosis is performed on the left side of the gastric stump. The afferent loop is placed on the smaller curvature side and efferent one on the greater. Care is taken to suture the afferent loop higher than the efferent to facilitate gastric emtying in the effernt loop (Hofmeister-Finsterer Technique).
The omentum is loosely sutured at the level of the gastroenteroanastomosis leaving the gastric stump in the upper mesocolic space.
The abdomen is closed on a Jackson-Pratt drain at the anastomosis.