STEP 7Anastomosis

Open anastomosis:

Through a small midline laparotomy a standard Billroth II or Roux-en-Y reconstruction can be performed (A).

Laparoscopic anastomosis (Billroth II):

To perform a laparoscopic side-to-side gastrojejunostomy, ligament of Treitz and the proximal jejunum are identified by lifting the transverse colon and tilting the table into a Trendelenburg position (head down). A loop of proximal jejunum is brought up in an antecolic or retrocolic fashion. This loop of jejunum is sutured to the anterior aspect of the stomach remnant with two resorbable, seromuscular stay sutures, approximately 2 cm apart. A stab incision in both the stomach and the jejunum is made with diathermia. Care should be taken that the incision in the stomach is made through all gastric wall layers. The stab incisions are enlarged, and the endostapler is introduced with one blade in the stomach and the other in the jejunum. Subsequently the stapler is fired one or two times, dependent on the size of the cartridges (60 or 45 mm). In case a 60-mm stapler is used, a 15-mm trocar should be introduced (B).

Was this article helpful?

0 0
How to Stay Young

How to Stay Young

For centuries, ever since the legendary Ponce de Leon went searching for the elusive Fountain of Youth, people have been looking for ways to slow down the aging process. Medical science has made great strides in keeping people alive longer by preventing and curing disease, and helping people to live healthier lives. Average life expectancy keeps increasing, and most of us can look forward to the chance to live much longer lives than our ancestors.

Get My Free Ebook

Post a comment