Minimal Invasive Conventional Surgery for GI Cancer: Review of 8 cases

Dr.Qalander H.Abdulkareem Kasanzani, Consultant Surgeon. Dr. Taher Abdulla Hawrami ,CABS, Consultant Surgeon, Assistant Professor of Surgery, University of Sulaimany, College of Medicine, Head of department of Surgery. Dr. Muhamed Shekhani,M.B.Ch.B- C.A.B.M, Consultant physician, Assistant Professor of Medicine, University of Sulaimany, College of Medicine, Department of Medicine. From Kurdistan Ceneter for GIT & Hepatology, Sulaimani Teaching Hospital.

45 years old male ,schizophrenic with many suicidal attempt .Lastly he swallowed corrosive substance which was used for polishing of the wall and the grounds of houses as they clamed . Then he had sever ulseration of the lesser curve of the stomach and sever stricture of the doudenum,which we failed to dilate by therapeutic endoscopy because it was involving the bulb and part of the send part of the duodenum .

Gastrojejunostomy has been done through 3.5 CM incision.

( Anterior isoperistaltic ,oblique type .using single layer ,extramucosal technique ) by PDS suture material .no drain and stomach tube was used for only 48 hours because of gastric outlet obstruction.

Uneventful recovery.

Psychiatrist has been consulted .

Case no. 8

stomach

jejunum

stomach

jejunum

The final anterior layer of gastrojejunostomy ,using single layer extramicosal method by interupted PDS Suture material

stomach

jejunum

Final 3.5 cm incision

80years old lady had gastric outlet obstruction and melaena for one month duration. Diagnostic work up has revealed distal gastric cancer ,poorly differentiated .

There was mild pelvic ascites and contrast C T scan abdomen has revealed multiple para aortic lymph node few of them were 6 cm and the cancer was distaly involving the stomach and seems to have no penetration to the surroundings .diagnostic laparoscopy has revealed peritoneal involvement .she had asthma and she was unfit for general anaesthesia .epidural anaesthesia was performed and 4 cm incision has been done at trans pyloric plane and was transverse upper abdominal incision . Distal palliative gastrectomy was done with Bilroth reconstruction using single layer through and through interrupted polydioxanon suture .she had un eventful recovery ,the excision was palliative because the cancer was advanced and the patient unfit for G A and it was bleeding and obstructing . She had uneventful recovery.

no stomach tube was left after preparation of the stomach preoperatively .she had oral fluid 2n post operatively freely. And freely mobile after 6 hours of surgery ,then discharged at 4th post operative day after verifying that every thing was uneventful .

kalandar .11 /2008/ sulaimany hospital

The tumour is bulging but in tis part the serosa is no involved grossly

the stomach, the incision and the umbilicus all seen in this view .for the comparison .

NB:

All the anastomosis done in the above cases were by single layer extra mucosal technique using monocryl (absorbable synthetic materials .except the last case which was by through and through method .

Discussion: Minimal invasive surgery is well known method of least trauma to

the patient & recently has been adopted increasingly in most of the centers universally.

Using expensive recent equipments & machines which are not always available & the maintenance of which needs both personnel & resources which is always a well known burden on the health sectors.

To avoid this limitations ; we can use our experience in the technique of surgery achieving the same goal of new technology but still using no equipments & doing the job by our conventional instruments & methods.

Discussion: The above points are the main keys for success. We use the term minimal invasive instead of minimal access

because it is really minimally invasive but not minimal access, it is enough access.

Conclusion& recommendation: Minimal invasive surgery can be done for selected cases safely by

using conventional methods rather than expensive equipments.