PMC2631538_01
Endoscopic finding before surgery. Arrowheads indicate the strictured antrum with normal mucosa.
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F1
On endoscopy, the antrum was so narrowed circumferentially that the endoscope could not be passed through, but surprisingly, the mucosa was normal without scarring (Fig. 1).
Our operative procedure. A mucosal incision was made circumferentially 5 mm proximal to the antral stricture (arrowheads: between inner and outer stay sutures) to allow the mucosa to be dissected free from underlying fibrotic scar tissue which was excised with great care not to perforate the gastric wall.
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F2
At laparotomy, gastrotomy was performed transversely over the antrum just proximal to the stricture and the lesion delivered through the incision (Fig. 2).
procedure continued: The mucosa, submucosa, and healthy muscle layers (arrows and arrowheads) were approximated.
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F3
The mucosa, submucosa, and healthy muscle layers were then approximated (Fig. 3).
Endoscopic finding 6 months after surgery. No stricture is seen.(arrowheads: the expanded antrum, double arrows: pyloric ring).
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F4
An endoscopic finding 6 months after surgery, no stricture is seen (Fig. 4).