{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T08:38:03Z","timestamp":1792831083838,"version":"4.5.0"},"reference-count":10,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":158,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Asian J Endoscop Surgery"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Gastric cancer associated with an upside\u2010down stomach, an advanced form of paraesophageal hiatal hernia, is rare, and laparoscopic surgery is technically demanding because of marked anatomical distortion. We report an 88\u2010year\u2010old woman with marked kyphosis who presented with vomiting and was diagnosed with early gastric cancer on the lesser curvature of the gastric angle. Computed tomography revealed a giant hiatal hernia with an upside\u2010down stomach. Laparoscopic distal gastrectomy with D1 plus lymphadenectomy and concomitant hiatal hernia repair were performed. The herniated stomach was first reduced into the abdominal cavity, followed by circumferential dissection of the hernia sac at the hiatus and mobilization of the lower esophagus. Lymphadenectomy was then performed with improved orientation. After gastric transection, the redundant hernia sac was excised before Roux\u2010en\u2010Y reconstruction and hiatal closure. The postoperative course was uneventful. This case suggests sac\u2010first dissection may be feasible for laparoscopic gastrectomy in patients with an upside\u2010down stomach.<\/jats:p>","DOI":"10.1111\/ases.70322","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T02:03:36Z","timestamp":1780970616000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Case of Laparoscopic Distal Gastrectomy for Early Gastric Cancer Associated With an Upside\u2010Down Stomach: Sac\u2010First Dissection Before Lymphadenectomy"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0771-540X","authenticated-orcid":false,"given":"Hideyuki","family":"Masui","sequence":"first","affiliation":[{"name":"Department of Surgery Hirakata Kohsai Hospital  Osaka Japan"},{"name":"Department of Surgery, Graduate School of Medicine Kyoto University  Kyoto 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