Laparoscopic Retrogastric Retrocolic Gastrojejunostomy Suture Repair in a patient presenting with Gastric outlet obstruction due to chemical injury of stomach, …
Dr Shashank Mishra, Professor, Postgraduate Department of Surgery, Subharti Medical College, MEERUT, UP, INDIA [email protected]
This is a surgical video demonstrating the feasibility of laparoscopic retrogastric retrocolic gastrojejunostomy without endoGI staplers by using suture material
A female in her 20's presented with history of acid ingestion around two months back
with nausea and vomiting episodes after every meals for the last 10 days
and features of gastric outlet obstruction…………
belonging to low socioeconomic status, we planned for Lap GJ(RGRC) with sutures only for this patient
This LapGJ (RGRC ) part -1 contains access to peritoneal cavity, access to lessar sac, making a jejunal mesenteric window for suture traction, making a retrocolic window and how to pass jejunal loops through this retrocolic window
Intraoperative vitals of the patient
During entire surgery, Three 10 mm and Three 5 mm ports were inserted as and when required following the baseball diamond principle with target organ – stomach
1st 10 mm = For 30 degree Laparoscope, 2nd and 3rd 10 mm and one 5 mm as working ports and 2nd and 3rd 5mm for applying traction and other miscellaneous tasks
Laparoscopic inspection of pylorus and antral region of stomach
Dissection for retrogastric area started
Access to lesser sac with Harmonic – Role of traction and counter traction
Left 5 mm and two 10 mm working ports simultaneously being used in co-ordination with working instruments
Greater curvature of stomach
Entry to lessar sac visualised
harmonic dissection of greater omentum leafs about 1 to 2 cm away from greater curvature
Avascular plane dissection for lesser sac
Retrogastric area with posterior stomach wall visible now
Identification of jejunal loops and DJ Junction is the second step
Laparoscopic walk over jejunum to identify DJ junction and appropriate standard length of jejunal loop
Duodeno-jejunal junction
Creation of jejunal window for suture traction around 40 cm from DJJ
placement of vicryl suture through jejunal window as suture traction to be used to pull jejunal loops through retrocolic window later on
a loose loop is formed with vicryl suture around the jejunum through window for traction
retrocolic window is formed and traction is applied over jejunum as shown here
Shaping the retrogastric area before pulling the loop of jejunum
anterior surface of pancreas visible
Site of proposed GJ anastomosis
Pulling of jejunal loops through retrocolic window with vicryl suture traction
Behind the transverse colon
Retrocolic jejunal loops visible
Completion of this part

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