Open Antrectomy and Duodenal Resection for Neuroendocrine Tumor

1. Anesthesia/Prep/Drape

• After adequate general endotracheal anesthesia was obtained, the patient was sterilely prepped and draped in standard fashion.

2. Exposure

1. Midline abdominal incision, enter peritoneum.
2. Entry of lesser sac using wide Kocher maneuver.
3. Evaluation of pylorus and duodenum.

3. Duodenal Resection

1. Ligation of right gastroepiploic artery and right gastric artery.
2. Examine pylorus and duodenum for tumor.
3. Division of duodenum.

4. Gastric Resection

1. Mobilization of stomach and division of short vessels along the lesser and greater curvature.
2. Resection of Antrum and send specimen for pathology.

5. Retrocolic Gastrojejunostomy

1. Mobilization of jejunum to stomach in retrocolic fashion.
2. Two-layer anastomosis:
   • Interrupted 3-0 silk (outer layer).
   • Running 3-0 Vicryl (inner layer).
3. Lembert sutures.
4. Bring anastomosis through trap and suture in place.

6. Closure

1. Abdominal fascia closed with #1 running Prolene.
2. Skin closed with staples.