An Innovative Technique for Circular Stapler Insertion and Wound Protection During Gastrojejunostomy

Alian Garay, MD, Danny V Martinec, BS, Valerie J Halpin, MD. Legacy Good Samaritan Hospital, Portland, OR

Our innovative method for inserting the circular stapler to create the gastrojejunal (GJ) anastamosis in laparoscopic roux-en-Y gastric bypass saves time and prevents wound infections. This technique requires the use of a specially designed tapered prosthetic at the tip of the circular stapler and a wound protector. The prosthetic is placed on the stapling end of the circular stapler over the extruding pin and held in place with a clamp and a #1 nylon suture placed through a hole near its tip. The 15 mm port is removed. The fascial defect is stretched with a pean. The wound protector is placed on to the abdominal wall at this site and the lubricated stapler apparatus is inserted through the wound protector. The extruding pin is withdrawn allowing the prosthetic to fall into the abdominal cavity with control of it held by the clamp and #1 nylon which are still extracorporeal. The stapler is intubated into the small bowel, the anastamosis is created in the usual fashion, and the stapler is removed through the wound protector. The clamp holding the #1 nylon and the prosthetic is then pulled to remove the prosthetic from the abdominal cavity through the wound protector. The enterotomy is closed by stapling off the stump of jejunum near the GJ anastamosis. A pean is inserted under direct vision through the wound protector and the bowel remnant is grasped and removed from the abdominal cavity. Insufflation is maintained during this process by twisting the wound protector, which closes the aperture of the abdominal wall defect. A finger is inserted and the wound protector is inverted and removed. The surgeon’s gloves are changed and the 15 mm port is replaced. At the end of the case, a single transabdominal fascial stitch closes the defect.


Session: SS07
Program Number: V021

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