STEP 1Exposure

Laparotomy and inspection are performed of the peritoneum, liver and, after mobilization of the duodenum by the Kocher maneuver, the para-aortic area. After cytological washings out of the Douglas space, one or two Kent type retractors with one or two octopus retractors are inserted for best overall view of the epigastric region, especially the diaphragmatic esophageal hiatus. Excision of the ensisternum is recommended.

Steps of the preparation of the gastrectomy are described in the chapter "Total Gastrectomy with Conventional Lymphadenectomy."

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