# 2489 Endoscopically-Guided, Laparoscopic Intragastric Resection of Gastric Stromal Tumors R. Matthew Walsh, B. Todd Heniford, Fred Brody, Cleveland, OH, Charlotte, NC
Myogenic neoplasms of the stomach are the most common submucosal gastric mass. Their natural history is indeterminant, and surgical resection is advised regardless of size. These lesions have typically required open resection, but a variety of laparoscopic techniques have been described. We report results of endoscopically-guided, laparoscopic intragastric enucleation. Eleven lesions have been excised in ten patients in the last three years. There were seven women and three men with a mean age of 58 years (range, 34-72 years). All patients were asymptomatic, and no lesions had mucosal ulceration. Seven lesions were located at the gastroesophageal junction, two at the incisura, and one each in the fundus and posterior wall of the corpus. The lesion of the posterior wall was transmural, all others were intra-luminal. The diagnosis of a myogenic lesion was confirmed by endoscopic ultrasound in eight patients. The laparoscopic/endoscopic technique included two or three, 2-mm or 5-mm intragastric trocars; endoscopic visualization, suture passage and specimen removal; and laparoscopic intragastric suture-repair of the gastric defect. The mean operative time was 201 minutes. The mean size of the resected specimens was 4.16 cm (range, 2.0-7.0 cm). There was no mitotic activity on histopathology, and all were considered pathologically benign. The median length of stay was 3.5 days (range, 3-8 days). There was no mortality or operative morbidity. At a mean follow-up of 12.3 months (range, 1-32 months) there has been no local recurrences. A combined endolaparoscopic intragastric resection is appropriate for intraluminal, benign-appearing submucosal lesions of the proximal stomach.