Laparoscopic Gastric Bypass Revision
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Procedure Outline
Table of Contents
General anesthesia achieved in the operating room.
Patient positioned supine with pressure points padded and foot support at end of bed to allow deep reverse Trendelenburg.
positioning- Mobilization of Liver
- Hiatal dissection
- Identify and divide posterior Vagus nerve
- Identify and divide anterior Vagus
- Identify GE junction
- Placement of sutures
- Remove adhesions and mesentery
- Dissection of Stomach
- Division of Gastric remnant
- Dissection of remnant off of pouch
- Dissection of remnant/pouch/roux limb confluence (resection of ulcer)
- Completion of remnant dissection
- Oversew staple line of remnant
- Mobilize Jejunal mesentery
- Evaluation of Jejunal anastomosis
- Evaluation of Jejunal common channel
- Division of attachments of roux limb to mesocolon
- Identification of Ligament of Treitz/creation of mesocolonic window
- Passage of Jejunum through transverse mesocolon
- First layer of anastomosis
- Testing of anastomosis
- Second layer of anastomosis
- Close mesenteric defects
- Remove specimen
- Close port sites