CHAPTER 25 Handsewn gastrojejunal anastomosis
Step 2. Preoperative considerations
♦ For details regarding patient preparation, anesthetic considerations, room set-up & patient positioning, see Chapter 24.
Step 3. Operative steps
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.
♦ The stomach is divided transversely using a 45-mm endoscopic gastrointestinal stapler transversely.
♦ This is followed by additional vertical firings of 60 mm Gold cartridges up to the previously mobilized angle of His. A slim gastric pouch (approximately 15 cc’s) is created entirely based on the lesser curvature.
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