Whilst recently doing a laparoscopic nissen’s fundoplication a firm mobile mass was found at the OG junction (anterior wall). The patient had been worked up appropriately for this procedure (OGD - no evidence of abnormality), ph stories and manometry.
we pondered what we should do next and did an ogd - again normal. The patient was extremely symptomatic from reflux with good objective evidence from ph studies and manometry do we proceeded with a posterior (partial) wrap rather than the Nissen’s. We plan to CT scan this lady in the elective setting to determine if this was in fact a GIST.
would anyone do otherwise or advise if you have had similar experience in this sitUstinov and if so what did you do?
This is a very interesting case. The decision should be taken according to the size. The best would be a partial stomac resection, eventually covered by the flap.
Article Coincidental Detection of Gastrointestinal Stromal Tumors Du...
Hi Mr Porter,
My opinion is the you should abandon the procedure, inform the patient regarding the findings and refer to the sarcoma MDT!
Thanks,
Antonios Athanasiou
Difficult ethically to proceed to a gist resection at the cardia without consent. Stop the operation having assessed the gist (lap and endoscopically) then consent for both