Background: The incidental finding of gastrointestinal stromal tumours (GISTs) in bariatric procedures is 2%.1The current approach to the management of GISTs is excision, with active surveillance an option for nodules <2cm.2 The aim of this study was to determine the incidence and intraoperative management of incidental small (<2cm) GISTs located at the fundus at the time of anti-reflux surgery, that would be inaccessible to surveillance under the fundoplication wrap.
Methods: This is a single-centre, retrospective study of 151 patients who underwent laparoscopic anterior 180o partial fundoplication for gastro-oesophageal reflux disease in the period Jan 2019 to July 2024. All patients underwent pre-operative gastroscopy. Intra-operative incidental detection of GISTs that were concurrently resected and confirmed on histopathology were recorded for tumour size, location and mitotic index.
Results: Eight (5.2 %) patients had confirmed resected GISTs. Six (75%) were detected in females with a median age 80 (range 61-83). All eight tumours were located at the gastric fundus ranging from 0.1-5cm in size, resected completely with clear margins and low mitotic activity. No adjuvant treatment was required. There was no recorded recurrence over a median follow up period of 17 months (range 5-48).
Conclusion: Incidental GISTs located at the time of anti-reflux surgery was within the range of incidental GISTs for other gastric surgical procedures. Concurrent resection of intra-operative incidental GISTs should be considered given the endoscopic, radiological and laparoscopic challenge in active surveillance for this cohort of patients who have undergone a fundoplication wrap.