subject: Gastric Surgery Procedure [print this page] Gastric Surgery Procedure Gastric Surgery Procedure
Once Laparoscopic entry to the upper abdomen is accomplished; ports are placed. For exposure of the liver a retraction is needed to be through. Using medical instruments a circular cut is made to create a tunnel around the proximal stomach. Using a grasper, you want to overtake an encircling lap-band around the proximal stomach and make sure its "locked". make sure you use sutures to decrease use of slipping. The band tubing is brought into a deep subcutaneous position and connected to its reservoir, implanted into the abdominal wall, allowing percutaneous access to inject or withdraw saline to tweak the dimensions of the band. The wounds are closed.
Through an upper midline cut, the abdomen is entered. cholecystectomy can be performed, if gallstones are known in preperation of procedure. The distal esophagus and proximal stomach are mobilized and the gastro hepatic ligament is incised. A drain or catheter can be required for traction. Between the first and second branches of the left gastric artery, staple the stomach (3 rows) or stapled and transected when your postive that the tubes (e.g. nasogastric or esophageal stethoscope) are first withdrawn. You can use the catheter or drain to help steer the stapler. There should be a 30 ml capacity for the proximal pouch.
At 45 cm distal to the ligament of Treitz, divide the jejunum. An 8 to 12 cm segment may be excised to permit more mobility for the ensuing gastric pouch anastomosis (without undue tension in these obese parts). Connect the distal jejunum and proximal limb (45 to 150 cm from the site of division, depending on the desired weight loss assessment) employing a linear stapler. attach the gastric pouch and distal limb, usually retrocolic, via a cut in the transverse mesocolon. Hand-sewn or staple technique may be used. The anesthesia provider passes a Maloney or hurst dilator through the throat (esophagus) prior to the anterior anastomotic surface is complete to make certain a stoma of this circumfrance. Then enter and inserted a nasogastric tube, and methylene blue dye (diluted) is instilled to test for anastomotic leakage. Leave the tube in the jejuna limb. If you want to decompress the extra gastric remains, than a gastrostomy may be done. You can then close the mesenteric defects. Antibiotic irrigation of the subcutaneous tissues should be done. The wound is closed.
You can do this operation laparoscopically, A good surgical tools to have accessible is the circular stapler, the anvil of which is passed perorally in the esophagus (when possible) in correlation with a percutaneously passed snare wire that is used retrogradely to grab the anvil for the pouch-jejunal anastomosis. Accuring a linear stapler, (like a GIA). Also hand-assisted technique using a hand port, e.g. LAP-PORT may be employed.
