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Total esophagogastric dissociation
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Riccardo Coletta, Antonino Morabito
Bowel continuity is established by end-to-side jejunojejunostomy approximately 40 cm distal to the esophageal anastomosis using inverted vertical mattress suture with an absorbable monofilament (5/0 Maxon) (Figure 29.6) and also a transanastomotic tube is inserted. However, a 20–30 cm Roux-en-Y from the esophagojejunal anastomosis is usually adequate in the pediatric population.
Obese Patient (BMI 32) with Reflux Disease and Diabetes Mellitus
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
The authors’ preference for the Roux limb is an antecolic antegastric pathway as opposed to retrocolic retrogastric. This eliminates the potential for an internal hernia at the mesocolon. The surgeon, however, should be able to perform a retrocolic and retrogastric approach if there is too much tension on the gastrojejunostomy with an antecolic approach. The enteroenterostomy, or side-to-side jejunojejunostomy, is performed using a single fire of a 60 mm EndoGIA tan stapler. Anchoring sutures are used to align the two lengths of small bowel with the stapler. The remaining enterotomy is closed with a running 2-0 polyglyconate suture. The small bowel is then divided using another EndoGIA 60 mm tan stapler separating the Roux limb from the enteroenterostomy (Figure 8.3). Most surgeons would then believe that the jejunal and Petersen’s space need to be closed with a 2-0 non-absorbable suture, although evidence for this is still inconclusive.
Weight Loss by Surgical Intervention
Published in Nathalie Bergeron, Patty W. Siri-Tarino, George A. Bray, Ronald M. Krauss, Nutrition and Cardiometabolic Health, 2017
Karim Kheniser, Sangeeta Kashyap, Nathalie Bergeron, Patty W. Siri-Tarino, George A. Bray, Ronald M. Krauss
Suited for individuals who have a propensity to ingest sweets and patients with gastroesophageal reflux disease (Buchwald 2002), the purpose of Roux-en-Y gastric bypass is to induce weight loss by reducing gastric volume to ≤30 mL and diverting ingested foods away from the distal stomach, duodenum, and minute (~initial 10 cm) segments of the jejunum (Elder and Wolfe 2007; Pories et al. 1995). The gastric pouch is created by segmenting the stomach into upper and lower quadrants, of which the lower or remnant pouch is bypassed (Moize et al. 2003). After the jejunum is transected distally from the ligament of Treitz, gastrojejunostomy and jejunojejunostomy are formed. The Roux limb, biliopancreatic limb, and common limb are denoted as representing the increments from the gastrojejunostomy to the jejunojejunostomy, from the ligament of Treitz to the jejunojejunostomy, and from the jejunojejunostomy to the ileocecal valve, respectively (Chen et al. 2013; Elder and Wolfe 2007; Gletsu-Miller and Wright 2013). Depending on the size of Roux and common limbs, the procedure can be designated as a long-limb or short-limb procedure.
Anterograde jejunojejunal intussusception through the distal anastomosis as complication after Roux-en-Y gastric bypass
Published in Acta Chirurgica Belgica, 2019
Sebastien Michiels, Caroline Delier, Patrick Philippart
On examination, the patient was afebrile and had normal vital signs. Abdominal examination revealed moderate tenderness in the periumbilical region with no rebound tenderness or guarding and no organomegaly. Urinary and blood tests were normal. Abdominal echography showed multiples gallstones without cholecystitis or biliary dilatation and suspected a small bowel invagination in the left abdominal side. Computed tomography scan of the abdomen revealed small bowel intussusception involving the jejunojejunal anastomosis with proximal bowel dilation (Figure 1). She was taken to the operating room for exploratory laparotomy which confirmed the diagnosis of intussusception. She was found to have a peristaltic (anterograde) intussusception of the roux limb into the jejunojejunostomy. Examination of the remaining abdominal cavity was unremarkable. A lead point was not identified. Approximately 10 cm of proximal (Roux-limb) small bowel had telescoped through the jejunojejunal anastomosis into a blind intestinal loop. The intussusceptum was the alimentary limb and the intussuscipiens was a blind loop corresponding to the extremity of the biliary limb. After manual reduction, all of the involved bowel appeared viable (Figure 2). We resected the blind extremity of the biliopancreatic limb to prevent recurrence (Figure 3). The patient had an unremarkable postoperative course and was discharged on postoperative day five. Histopathological analysis was normal.
Technical aspects and standardization of the totally robotic Roux-en-Y gastric bypass. Results of a single surgeon experience with a 5-year follow-up
Published in Acta Chirurgica Belgica, 2022
Emmelie Reynvoet, Veerle Van Vlodrop, Kurt Hendrick, Dries Vandeweyer, Carlos Vaz
After creation of the gastrojejunostomy the alimentary limb is counted, generally at 100 cm. We use two prograsps to manipulate the bowel (Figure 7(1)). The alimentary limb and the biliopancreatic limb are aligned in the correct orientation to perform a side-to-side anastomosis. A enterotomy is performed in both limbs at the antimesenteric side. A stapler is introduced in both enterotomies and a jejunojejunostomy is created. The enterotomy is closed with the Vicryl 3/0 20 cm running suture, starting at the mesenteric gap, and suturing upwards (Figure 7(2)).
The Predictive Value of a New Inflammatory-Nutritional Score for Quality of Life after Laparoscopic Distal Gastrectomy for Gastric Cancer
Published in Nutrition and Cancer, 2023
Simeng Zhang, Ruiqing Liu, Maoshen Zhang, JiLin Hu, Shuai Xiang, Zinian Jiang, Dongsheng Wang
Roux-en-Y reconstruction was used in all patients in this study. After the distal gastrectomy, the jejunum was cut off at a distance of 20-30 cm from the Treitz ligament, and side-to-side jejunojejunostomy was performed with a linear stapler. Then isoperistaltic gastrojejunostomy was performed with a linear stapler through the antecolic route, and the stump was closed with a linear stapler.