Hand-sewn Lap Gastric Bypass - Mastery Of Surgery
At BMI, we favor the hand-sewn technique (I learnt this in 2006 watching K Higa) of pouch-jejunal anastomosis in the bariatric operation of lap gastric bypass. The procedure shows the initial assessment of the suitability of the gastric pouch formation, followed by the entire infracolic part of the operation. The jejunum is measured at 75-100 cm from the Ligament of Treitz an transected. The distal (alimentary) limb is taken up towards the stomach and a jejuno-jejunal anastomosis performed at 100 cm (150 cm in some) between the proximal (biliopancreatic) limb and the rest of the small bowel. The staple lines are reinforced with stitches that also close the mesenteric defects to prevent internal hernia formation. The pouch is next formed by serial firings of the blue load of the stapler. The stoma is hand-sewn with 3-0 Vicryl and sized at 18 mm over a gastric tube. The stoma is 4-layered and leak-proof. As they say, don't try this at home (suturing mastery advisable)! ;-)
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