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A D V E R T I S E M E N T
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A D V E R T I S E M E N T | |||||
Laparoscopic Roux-en-Y Gastric Bypass Images | ||||||
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Laparoscopic port placement. |
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Port 4 is used for liver retractor. |
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Gastrohepatic omentum is divided toward the esophageal hiatus. |
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Fundus of stomach is freed from diaphragmatic attachments. |
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16 Fr. balloon tipped catheter introduced and inflated with 15cc of air. |
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Balloon pulled back to the esophago-gastric junction. |
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Small gastrotomy on the lesser curve side of the balloon is made with a 3mm spatula-tipped monopolar cautery. |
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Balloon may be ruptured. |
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A 2cm gastrotomy is made 4cm distal to the small gastrotomy using cautery scissors. |
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Gastrotomy shown. |
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Cholangiogram catheter with a 3-0 prolene suture tied in a loop proximal to the balloon is introduced into the small gastrotomy. |
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Balloon is inflated after insertion. |
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Inflated balloon. |
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Catheter tip grasped… |
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...and pulled out through the large gastrotomy. |
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Balloon extracted. |
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21 mm endoscopic circular stapler anvil introduced into abdomen, with loop of 2-0 silk tied through tip of anvil stem prior to introduction. |
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Anvil loop is passed through catheter loop, then slipped around anvil to lock the two together. |
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Cholangiogram catheter is withdrawn... |
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...to pull anvil through the larger gastrotomy... |
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...and then pull the stem out the small gastrotomy. |
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Stem secured in place... |
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...with 3-0 silk purse string suture. |
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Large gastrotomy closed with endoscopic linear cutter. |
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Starting on the lesser curve just caudal to the anvil... |
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...the space behind the stomach is opened bluntly. |
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Staple-line reinforcement material is used on stapler during division of the stomach to protect against bleeding and leakage. |
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Second firing of endoscopic linear cutter is directed from the end of the first reinforced staple line toward the cardia just lateral to the angle of His. |
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Gastro-colic omentum opened along greater curve of stomach. |
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Opening made in an avascular part of the transverse mesocolon. |
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Transverse mesocolon opened. |
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Penrose drain placed through opening in transverse mesocolon. |
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Greater omentum lifted to identify the jejunum at the ligament of Treitz. |
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Bowel is followed a distance of 15-20cm and divided. |
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Bowel division complete. |
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End of Penrose drain sutured to distal end of divided bowel. |
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Side-to-side stapled anastomosis created between proximal limb and side of distal limb. |
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Penrose drain pulled from above the transverse mesocolon, drawing free end of jejunum through in a retrocolic, ante-gastric position. |
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End of bypass limb directed to patient's left, and a large enterotomy created near end of limb with cautery scissors. |
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Endoscopic circular stapler introduced into the enterotomy and advanced 4-6 cm. |
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Male end of circular stapler brought out through antemesenteric side of jejunum... |
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...and stem insert is removed from anvil. |
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Male and female ends... |
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...are joined... |
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...and stapler is closed slowly... |
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...and stapler is closed slowly... |
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Stapler removed by gently rotating and tissue donuts inspected for completeness. |
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Endoscopic linear cutter used to remove free end of jejunum, including the enterotomy. |
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This page was last modified on 1/13/2000. A D V E R T I S E M E N T
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