Partial “Wedge” Gastrectomy 
Richard Davis 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
Introduction:  
 
The partial gastrectomy, also known as 
wedge gastrectomy, is useful for gastric tumors that 
require only limited resection. Most gastric tumors 
are adenocarcinomas and require margins of 5cm; 
formal gastric resections (Distal, Subtotal or Total 
gastrectomy) are described elsewhere in this atlas.  
Situations that demand only a localized 
resection are rarer.  These include Gastrointestinal 
Stromal tumors, Neuroendocrine tumors (formerly 
called “Carcinoid,”) and gastric lymphomas that 
have perforated during chemotherapy. In such cases 
a margin of 1cm is acceptable. The focus should be 
on removing the tumor, maintaining the reservoir 
function of the stomach, and assuring a closure that 
will be unlikely to leak postoperatively.  
 
Be careful using partial gastrectomy on the 
lesser curvature of the stomach: it is possible to 
resect small tumors here, but at least one branch of 
the vagus nerve should be preserved. If this is not 
possible, perform a distal or subtotal gastrectomy 
instead. If both branches of the vagus are severed, the 
stomach will not drain properly. 
The surgeon must be certain of the histology 
of the tumor: using wedge gastrectomy as an 
“excisional biopsy” is unwise, as the most likely 
cause of a neoplastic mass in the stomach is 
adenocarcinoma. If you have no access to 
immunostaining, a gastric spindle cell neoplasm in 
the submucosa of the stomach wall (by plain 
histology) is enough evidence to assume a 
Gastrointestinal Stromal tumor, in our opinion. If 
you have no access to pathology services at all, 
formal gastric resection with 5cm margins is the right 
almost all of the time.  
 
Partial gastrectomy proceeds in the following 
steps:   
● Exploration of the abdomen 
● Complete mobilization of the stomach, including 
entry into the lesser sac if necessary 
● Excision of the tumor 
● Closure of the gastric wall 
 
Steps: 
1. Midline abdominal incision is suitable for most 
cases of partial gastrectomy. For a tumor 
confined to the fundus a left subcostal incision is 
also acceptable.  
2. Explore 
the 
abdomen 
thoroughly; 
Neuroendocrine tumors are prone to metastasize 
to the liver. Locate the tumor and assess for local 
invasion of any adjacent structures. 
 
This tumor is located along the greater curvature below the 
gastroepiploic vessels, which will be resected adjacent to the 
tumor, along with the attached omentum. 
 
3. If necessary, enter the lesser sac through the 
avascular plane between the omentum and the 
left transverse colon. Expand this entry to the left 
and right until the tumor is clearly visible. This 
plane can be developed to the patient’s right all 
the way to the origin of the right gastroepiploic 
artery, and to the left all the way to the 
esophageal hiatus and short gastric vessels. 
Avoid ligating any of the stomach’s blood supply 
that is not necessary for the resection. Take 
special care to preserve the short gastric vessels 
if possible.  
Partial “Wedge” Gastrectomy 
Richard Davis 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
 
The avascular plane between the colon and omentum allows 
easy entry into the lesser sac and access to the posterior 
stomach. The avascular space is opened by the hands of the 
surgeon on the patient’s left.  
 
 
Division of the plane between the colon and omentum reveals 
the lesser sac, posterior gastric wall, and the tumor.  
 
4. If the tumor is adjacent to the gastroepiploic 
vessels, ligate these on either side and divide the 
omentum that will be removed with the 
specimen.  
 
The gastroepiploic vessels are ligated on either side of the 
tumor. The omentum supplied by the devascularized portion of 
these vessels must be resected as well.  
 
  
The divided gastroepiploic arcade and omentum adjacent to the 
tumor. 
 
5. It can be difficult to assess the margins from 
outside the stomach. Evaluate the gastric wall 
adjacent to the tumor by gently pinching it. 
Partial “Wedge” Gastrectomy 
Richard Davis 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
 
Gently palpating the gastric wall adjacent to the tumor allows 
it to be assessed and a line of incision planned.  
 
6. Once you have chosen a likely margin, score the 
serosal surface with gentle taps with the 
diathermy. Do not make these marks very deep; 
upon opening the stomach you may choose a 
different line of excision.  
 
Gently scoring the serosa in the area of planned incision. These 
are not deep marks, so the line of incision can be changed once 
the tumor is seen from inside the lumen of the stomach.  
7. Open one part of the stomach along the line you 
have chosen. Go slowly and assure hemostasis, 
as the stomach is prone to bleed when divided. 
 
The stomach is opened in one location and the tumor is 
visualized from inside. The incision is then extended.  
 
8. Once the stomach is open enough to see the 
tumor, adjust your planned lines of excision if 
necessary. Avoid removing more than a 1cm 
margin.  
 
As the tumor becomes more visible, it is easier to assure that 
the margin of excision is neither too large nor too small.  
 
9. Complete the tumor excision. 
Partial “Wedge” Gastrectomy 
Richard Davis 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
 
Completing the excision, taking care to control bleeding points 
on the cut stomach wall.  
 
10. Decide on the orientation of the closure that will 
most closely preserve the stomach’s reservoir 
function. Avoid narrowing the stomach in the 
mid-portion and thus dividing it into “two 
compartments.”  
 
In this case, the decision was made to close the stomach 
transversely, as a longitudinal closure might have narrowed it 
and led to two compartments connected by a narrow tube.  
 
11. Close the stomach in two layers: the first layer 
will be the mucosa and submucosa only.  
 
As the serosa retracts after the stomach is cut, it is easy to close 
in two layers, with the mucosa and submucosa only in the first 
layer. The tip of the nasogastric tube is seen in the lower part 
of the gastrotomy. This should be pulled back to avoid any 
pressure on the suture line.  
 
 
The first layer of closure, completed.  
 
12. The second layer will be seromuscular sutures to 
invert the first suture line.  
Partial “Wedge” Gastrectomy 
Richard Davis 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
 
Interrupted seromuscular sutures invert the first suture line 
completely.  
 
 
The completed closure of the gastric wall.  
13. In 
cases 
of 
malnutrition 
or 
ongoing 
chemotherapy, we prefer to reinforce the suture 
line with a “tongue” of omentum, a third layer, 
secured with seromuscular sutures that bury the 
suture line further within the omentum. 
 
Pitfalls 
● Suture line leak is best prevented by meticulous 
technique. Strive for a technically perfect first 
layer and then completely invert the suture line 
with the second layer. Our practice is to leave a 
nasogastric tube in place and remove it on the 
first postoperative day if the abdomen is not 
distended. 
● Devascularizing the stomach by taking too large 
of a portion of it is a devastating complication. 
When this occurs, your best option is converting 
the resection to a subtotal gastrectomy. This will 
only be possible if the short gastric vessels are 
still intact, as they are the main blood supply to 
the 
remnant 
stomach 
after 
a 
subtotal 
gastrectomy. If you need to divide the short 
gastric vessels during a wedge gastrectomy, do 
so only if you are sure you will not need to 
convert to a subtotal gastrectomy (one example 
would be a tumor confined to the fundus.) 
Carefully inspect the mucosa and serosa at the 
end of the resection to be sure it is a normal color. 
Compare the color of the stomach serosa to the 
small intestine if necessary. 
● Patients on active chemotherapy for gastric 
lymphoma with a perforated tumor present a 
special challenge. Wedge resection with 1cm 
margins is appropriate oncologically, affords the 
patient the smallest operation possible, and 
allows closure with viable tissue. But due to poor 
nutrition and steroid use, these operations are 
most prone to leakage and other complications. 
You are wise to leave the NG tube in for a longer 
time. As with any gastric or esophageal surgery 
on a malnourished patient, place a feeding 
jejunostomy tube. This allows you to manage a 
small leak with drainage alone and maintain 
nutrition. An omental patch sutured loosely over 
your two layer closure acts as another “safety 
net” in any patient at risk for complications.  
 
Partial “Wedge” Gastrectomy 
Richard Davis 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
Richard Davis MD FACS FCS(ECSA) 
AIC Kijabe Hospital 
Kenya 
 
April 2022   
