Gastric Surgery Surgery

Once Laparoscopic entrance to the upper abdomen is accomplished; ports are placed. Retraction of the liver is often necessary for exposure. Using medical instruments a circular incision is prepared to create a tunnel around the proximal stomach. Using a grasper, you want to consider to pass 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 then put in a deep subcutaneous state is then attached to the reservoir, implanted into the abdominal wall, allowing percutaneous access to withdrawal or inject saline to alter the sides of the band. The wounds are closed.

Through an upper midline incision, the abdomen is then entered. If gallstones are noted (or documented on pre-operative X-ray) cholecystectomy may be done. When the gastro hepatic ligament is incised the proximal stomach and distal esophagus can be mobilized. A drain or catheter can be needed for traction. Between the 2 branches of the left gastric artery, staple the stomach (three rows) or transected and stapled when your postive that the tubes (e.g. nasogastric or esophageal stethoscope) are first withdrawn. You can use the catheter or drain to help guide the stapler. The proximal pouch produced should have 30 ml amount.

At 45 cm to the ligament of Treitz, divide the jejunum. To allow more mobility, an eight to twelve cm excise can be used to promote 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 preferred weight loss assessment) using a linear stapler. The distal limb is anatomized to the gastric pouch, usually retrocolic, by an incursion into the transverse mesocolon. Hand-sewn or staple technique may be used. The anesthesia doctor passes a Maloney or hurst dilator down the throat before the anterior anastomotic surface is complete to assure a stoma of this circumfrance. Then enter and inserted a nasogastric tube, and methylene blue dye (diluted) is used to check and see if thier is anastomotic leakage. The tube is left in the jejuna limb. A gastrostomy can be performed to decompress the excluded gastric remnant. All mesenteric defects are closed. You can then use antibiotic spray of the subcutaneous tissue. Close the wound.

This procedure may be performed laparoscopically, using a disposable endoscopic circular stapler as one of your medical tools, the anvil at times can be passed occasionally through the throat (esophagus) (if necessary) in correlation with a careful passed snare wire that is required retrogradely to grab the anvil for the pouch-jejunal anastomosis. Accuring a linear stapler, (like a GIA). Using a hand-port for a hand-assisted technique, e.g. LAP-PORT may be employed.


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A "Laparoscopic Gastric Banding Surgery" editorial is by Rick W.