Laparoscopic Central Gastrectomy for a Gastric Schwannoma: Case Report

Introduction: Schwannomas are tumors originating from any peripheral nerve that rarely arise in the stomach. Presentation of Case: A 77-year-old woman with nonspecific epigastric pain. EGD reveals a submucosal bulge on the anterior wall of the gastric body. EUS showed a heterogeneous mass compatible with GIST. We performed a laparoscopic central gastrectomy because a wedge resection wasn’t possible for the tumor localization. Biopsy reveals it was a Schwannoma. Discussion: Gastric Schwannomas are atypical mesenchymal gastric tumors that usually have non-specific symptoms. Preoperative workup is made by EGD, EUS and CT but, commonly those methods couldn’t do the differential diagnosis with GIST. Surgery is the treatment. Because it is not necessary to perform a lymphadenectomy, the type of gastrectomy could be choosing within total, distal, wedge or atypical resection, depending tumor size and location. There are not publications about central gastrectomy for GS. Therefore, we decided to present this patient with a CG for GS, that showed good outcomes. Conclusion: Central gastrectomy is an available option for Gastric Schwannomas when lateral or wedge resection couldn’t be performed.

Use of absorbable meshes in laparoscopic paraesophageal hernia repair

Paraesophageal hernia (PEH) repair is one of the most challenging upper gastrointestinal operations. Its high rate of recurrence is due mostly to the low quality of the crura and size of the hiatal defect. In an attempt to diminish the recurrence rates, some clinical investigators have begun performing mesh-reinforced cruroplasty with nonabsorbable meshes like polypropylene or polytetrafluoroethylene. The main problem with these materials is the occurrence, in some patients, of serious mesh-related morbidities, such as erosions into the stomach and the esophagus, some of which necessitate subsequent esophagectomy or gastrectomy. Absorbable meshes can be synthetic or biological and were introduced in recent years for PEH repair with the intent of diminishing the recurrence rates observed after primary repair alone but, theoretically, without the risks of morbidities presented by the nonabsorbable meshes. The current role of absorbable meshes in PEH repair is still under debate, since there are few data regarding their long-term efficacy, particularly in terms of recurrence rates, morbidity, need for revision, and quality of life. In this opinion review, we analyze all the presently available evidence of reinforced cruroplasty for PEH repair using nonabsorbable meshes (synthetic or biological), focusing particularly on recurrence rates, mesh-related morbidity, and long-term quality of life.