A Simple Method to Aid Safe Resection Margin During Sleeve Gastrectomy in Patients With Incidental Gastric Lesions.

In contrast to colonic tattooing, data on dye-marking before gastric operations are scarce. A simple method of gastric tattooing before sleeve gastrectomy (SG) is presented. SG, under tattoo guidance has never been reported. Submucosa of the lesion is injected with 1 to 2 mL of carbon particles (Spot, PA) 24 hours before SG. At surgery, serosal dye stain is identified and stapling achieved with care to remove all dye-stained segment. Dye spread on the serosal surface differed significantly. However, as all the dye-stained segments were avoidable during stapling, 2 neuroendocrine tumors, 2 leiomyomas, and 1 benign ulcer were resected with clear histologic margins. The method presented herein may decrease the need for operative gastroscopy, mucosal resection, or laparoscopic gastrotomy in a number of patients. Because of the problem of the dye spreading, its utilization may be inappropriate in lesions that are closer to the minor curvature and incisura angularis in particular.