For creation of a permanent reverse gastrostomy, usually the greater curvature is used. The left gastroepiploic vessels represent the vascular pedicle of the tube. After interruption of the right gastroepiploic vessels at the site of the beginning of the tube, the gastro-colic and, if necessary, gastrosplenic ligaments are transected at a safe distance from the left vascular pedicle without compromising the integrity of the gastroepiploic arcade (A).
The basis of the tube is localized at the middle third of the greater curvature. The left gastroepiploic vessels are the vascular pedicle of the gastrostomy.
A sufficient length of the tube is achieved by two to three applications of a linear stapler, depending on the thickness of the abdominal wall. Inversion of the GIA suture lines is done by interrupted or running sutures(B).
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