Laparoscopic excision of leiomyomas in the esophageal and gastric wall

Laparoscopic minimally invasive procedures have become feasible and safe alternatives to open surgery in the management of esophageal and gastric leiomyomas. There are two major indications for the surgical management of these benign tumors: the presence of symptoms and the need for histopathologic confirmation if the biological behavior is unclear. The approach of choice for leiomyomas located in the very distal esophagus or gastroesophageal junction is the laparoscopic enucleation of the tumor. For the resection of gastric leiomyomas, three surgical procedures are primarily performed: the laparoscopic wedge resection without gastrotomy for tumors of the anterior gastric wall, lesser/greater curvature, and fundus; the laparoscopic wedge resection with gastrotomy for tumors of the posterior gastric wall ("transgastric approach"); and the laparoscopic intragastric resection for tumors of the posterior gastric wall ("intragastric approach"). This chapter summarizes these minimally invasive techniques and provides an update of the most recent clinical data that is available.