By Seung Ho Choi, Kazunori Kasama
Bariatric and Metabolic surgical procedure is well-known to be a tremendous and powerful alternative for the therapy of serious weight problems and a few of the linked stipulations and ailments. This e-book offers state-of-the-art wisdom on such surgical procedure with the purpose of facilitating the sharing and alternate of data, documenting potent recommendations, and embellishing defense and results. All technical points are coated intimately, and the textual content is complemented by way of many useful illustrations. a different key characteristic is the availability of accompanying surgical movies, as a way to be of worth to either beginner and skilled surgeons. This textbook can be an excellent asset in medical perform for all who're concerned or drawn to bariatric and metabolic surgery.
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To prevent gastroepiploic arcade bleeding, dissection begins from the transparent window very close to the greater curvature of the stomach, and ultrasonic coagulating shears or vessel-sealing system should be used. One should not perform blunt dissection and, instead, should make a small hole first with laparoscopic dissector and then cut the vessel with energy device under direct vision. Escaping from much tension between the stomach and spleen is important to avoid tearing the spleen. Reinforcement or buttress material may be helpful to prevent staple line bleeding.
9), the use of bougie is strongly recommended to calibrate sleeve size to prevent any constriction or injury of GE junction (Fig. 10). The stapler is fired consecutively along the bougie to His angle. When stapling, one should stretch the stomach by pulling the greater curvature side of the stomach laterally in order to make a well-lineated staple line and good-shaped gastric tube (Fig. 11). Placing the last staple should be parallel to the left diaphragmatic crus not to injure the esophagus (Fig.
3 4 LRYGB Consists of These Manipulations 1 1. 2. 3. 4. 5. Trocar insertion Jejunojejunostomy Gastric pouch formation Gastrojejunostomy Others (including mesenteric closure, leak test) Sequential order may depend on surgeons’ preference. Fig. 1 Trocar Insertion For morbidly obese patients, it is very difficult to do “open method” for the first trocar insertion. Initial entry is performed without insufflation using a 10 mm non-bladed optical trocar system. Using a bladed optical trocar system may cause serious injury to the blood vessels and lead to major hemorrhage, so we avoid using a bladed trocar for the first port.
Bariatric and Metabolic Surgery by Seung Ho Choi, Kazunori Kasama