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Laparoscopic Gastric Bypass Revision

Janey Sue Pratt, MD
Massachusetts General Hospital
Anesthesia

General anesthesia achieved in the operating room.

Patient Positioning

Patient positioned supine with pressure points padded and foot support at end of bed to allow deep reverse Trendelenburg.

positioning

Endoscopy/Port Placement

Lysis of Adhesions and Hiatal Dissection

  • Mobilization of Liver
  • Hiatal dissection

Surgical Intervention

Vagotomy

  • Identify and divide posterior Vagus nerve
  • Identify and divide anterior Vagus

Hiatal Hernia Repair

  • Identify GE junction
  • Placement of sutures

Division of Roux Limb

Partial Gastretomy/Resection of Ulcer

  1. Remove adhesions and mesentery
  2. Dissection of Stomach
  3. Division of Gastric remnant
  4. Dissection of remnant off of pouch
  5. Dissection of remnant/pouch/roux limb confluence (resection of ulcer)
  6. Completion of remnant dissection

Rerouting of Roux limb

  1. Oversew staple line of remnant
  2. Mobilize Jejunal mesentery
  3. Evaluation of Jejunal anastomosis
  4. Evaluation of Jejunal common channel
  5. Division of attachments of roux limb to mesocolon
  6. Identification of Ligament of Treitz/creation of mesocolonic window
  7. Passage of Jejunum through transverse mesocolon

New GJ Anastomosis

  1. First layer of anastomosis
  2. Testing of anastomosis
  3. Second layer of anastomosis

Endoscopy for Testing of Anastomosis

Closure

  • Close mesenteric defects
  • Remove specimen
  • Close port sites