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Contemporary Surgery WEBSURG VIDEO TIPSLaparoscopic Roux-en-Y gastric bypass: Division of the omentumMichel
Vix,
MD;
Jacques
Marescaux,
MD, FRCSStrasbourg, France 314Typical demonstration of a laparoscopic Roux-en-Y gastric bypass vd01en2334http://www.websurg.com/ref/contemporary-vd01en2334.htm
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M Vix (France) / J Marescaux (France)English31'2008-05-06Trocar positioningOperation begins with division of omentumIdentification of ligament of TreitzMeasurement (75cm), ligation and marking of biliary limbMeasurement of alimentary limb (150cm)Jejunojejunal anastomosisClosure of mesenteric defectCreation of gastric pouchPreparation of gastric side of gastrojejunal anastomosisDivision of jejunum (to separate alimentary from biliary limb)Preparation of jejunal side of gastrojejunal anastomosisConstruction of gastrojejunal anastomosisClosure of stapler entry siteGeneral and digestive > Stomach and duodenum > Morbid obesity > Gastric bypassThe authors make an incision below the xiphoid and insert the round stapler through a 12-mm trocar to do the gastrojejunostomy. The 5-mm trocar helps gain exposure of the small bowel and retract the liver, and an additional 12-mm trocar lateral to the umbilicus helps measure the limbs for the jejunojejunostomy. The first step is to reach the omentum to bring the loop up, and then mobilize the omentum over the transverse colon. With the 10-mm LigaSure Atlas device (Valleylab, Boulder, CO), the authors dissect and divide the omentum. They elevate the transverse colon high to visualize the ligament of Treitz.
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