Stapled Subtotal Gastrectomy

Fig. 5.1

Subtotal gastrectomy is selected when a satisfactory proximal resection margin can be obtained. There are several techniques to perform a stapled subtotal gastrectomy: total or partial inferior anastomosis, side-to-side anastomosis using a linear stapler (GIA), and circular anastomosis after closure and transection of the gastric stump with a GIA

Figs. 5.2 and 5.3

We prefer to close the gastric stump completely with a GIA stapler and then create a stapled end-to-side gastrojejunal circular anastomosis on defunctionalized Roux limb on the low lateral portion of the greater curvature

Figs. 5.4, 5.5 and 5.6

A GIA linear mechanical stapler allows closure and transection of the stomach along the transection line passing through the lesser and greater curvature and forming a 120–130° angle to the lesser curvature. This angle ensures adequate margins and removal of antral G cells. Before locking the stapler jaws, the NGT needs to be drawn back, to avoid inclusion in the staple line

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