Chapter 10: Table of Contents
Isolate the stomach from the remainder of the abdominal cavity using moist laparotomy sponges. Place two stay sutures (full thickness to ensure you engage the submucosa) in the less vascular portion of the stomach (oriented vertically between the greater and lesser curvature); plan to make your incision between these two sutures. Stab the stomach full thickness (the mucosa tends to separate away and is difficult to puncture) using a scalpel blade and extend your incision to the desired length using Metzembaum scissors. I typically make a 2cm incision because I find that shorter incisions are hard to close with a continuous suture pattern. Use Metzembaum scissors to cut a 2-5 mm wide elliptical edge of the stomach wall for biopsy; ensure that all layers, including the mucosa and serosa, are collected. Wipe the edges of the stomach with a gauze sponge or suction the lumen. Refrain from cauterizing, clamping or ligating bleeding vessels at the cut edge; these will stop when you suture the stomach closed. Close the incision in two layers using 3-0 Biosyn® or PDS®. Do not use chromic gut in the gastrointestinal tract. I place a full thickness, simple continuous pattern and I oversew with a Lembert or Cushing pattern. Wipe the serosal surface with a moist sponge before returning the stomach to the abdomen, remove the laparotomy sponges, cut the stay sutures and release the stomach.