# Laparoscopic endoscopic cooperative surgery for gastric subepithelial lesion during laparoscopic sleeve gastrectomy for severe obesity

## TL;DR

A patient with severe obesity had a stomach lesion removed during weight-loss surgery using a combined surgical technique.

## Contribution

A combined laparoscopic and endoscopic approach was used to safely remove a gastric lesion during sleeve gastrectomy.

## Key findings

- A 10 mm subepithelial lesion was successfully removed during laparoscopic sleeve gastrectomy.
- The combined surgical approach allowed for safe excision and gastric wall closure.
- The lesion was diagnosed as a benign leiomyoma post-surgery.

## Abstract

The frequency of pathologies detected incidentally before, during, and after a bariatric surgery, such as subepithelial lesion (SEL) of the stomach, is likely to rise as bariatric surgery becomes more common.

A 49-year-old female patient presented with severe obesity, for which laparoscopic sleeve gastrectomy (LSG) was planned. During a preoperative examination, endoscopy revealed a 10 mm SEL in the posterior wall of the upper body of the stomach. Excision of the SEL was performed simultaneously with the LSG. Endoscopy demonstrated that the SEL was situated on the remnant side of the stomach. Endoscopic resection using laparoscopic endoscopic cooperative surgery was performed for the SEL, and the thinned gastric wall was closed by hand-sewing. Thereafter, LSG was performed. Pathological analysis of the SEL led to a diagnosis of leiomyoma. The patient was discharged on postoperative day 6.

Surgeons should be prepared to manage incidentally detected pathologies before, during, and after bariatric surgery and to choose the surgical method most suitable to the individual patient.