Two-stage robotic gastrectomy after bypass surgery for a perforated non-curative endoscopic submucosal dissection...

Here, we report a case of scar perforation caused by endoscopic dilation while the patient was waiting for additional gastrectomy after non-curative endoscopic submucosal dissection (ESD) for early gastric cancer. Although conservative treatment prevented the progression of generalized peritonitis, one-stage meticulous surgery was contraindicated because of abscess formation around the pylorus, which is the main target of lymphatic dissection. Therefore, we performed a two-stage surgery. Prior laparoscopic gastrojejunal bypass for peritonitis control and nutritional management allowed for uncompromised curative gastrectomy using a robotic approach. Among the various treatment strategies, our selected two-stage surgery was useful in achieving uncompromised cancer surgery in patients with perforated peritonitis after noncurative ESD, where prophylactic dissection was the primary objective.

The online version contains supplementary material available at 10.1007/s13691-025-00766-x.