Handsewn gastrojejunal anastomosis

Published on 09/04/2015 by admin

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Last modified 09/04/2015

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CHAPTER 25 Handsewn gastrojejunal anastomosis

Edward Mun

Step 1. Surgical anatomy

♦ For pertinent anatomy, see Chapter 24.

Step 2. Preoperative considerations

♦ For details regarding patient preparation, anesthetic considerations, room set-up & patient positioning, see Chapter 24.

Equipment & instrumentation

Specialized equipment needed for a hand-sewn gastro-jejunal anastomosis includes:

♦ A needle driver for suturing and a left handed instrument, either a blunt grasper or curved tip grasper.

♦ A large (28 French) gastric evacuation tube, such as Ewald or Mallinkrodt Lavacuator tube (Covidien-Nellcor Products, Boulder, Colorado).

Step 3. Operative steps

Handsewn technique.

Access and port placement

See Figure 25-1 for port placement reference.

image

Figure 25-1

Creation of pouch

♦ For the construction of gastrojejunostomy (following completion of jejunojejunostomy), attention is turned to the upper abdomen for the retraction of the left lobe of the liver. A Nathanson retractor is placed in the epigastrium to elevate the liver, and the gastroesophageal junction is exposed.

♦ The angle of His is mobilized with a Harmonic scalpel.

♦ The pars flaccida of the gastrohepatic ligament is opened.

The lesser omentum, located approximately 6 cm from the GE junction, is divided with Harmonic scalpel up to the gastric wall of the lesser curvature.

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