Which finding is a relative contraindication to foregut laparoscopic procedures?

• A. Hepatosplenomegaly
• B. Chronic gastritis
• C. Normal GE junction
• D. No prior upper abdominal surgery

Answer: (A)

Foregut laparoscopic procedures depend on clear upper-abdominal anatomy and adequate space to safely mobilize the stomach and access the gastroesophageal junction. When the liver and spleen are enlarged (hepatosplenomegaly), they crowd the working area, distort landmarks, and increase the risk of injury to surrounding structures and to the short gastric vessels during maneuvers around the hiatus and fundus. This combination makes the operation technically more difficult and raises complication risk, so it is a relative contraindication to proceeding laparoscopically in some patients.

Chronic gastritis doesn’t inherently hinder laparoscopic access or visualization; a normal GE junction suggests no gross anatomic distortion requiring conversion or alternative approaches; and having no prior upper abdominal surgery typically reduces adhesions, making laparoscopy more feasible, not contraindicating it.