Image Category: Fundamentals:Cholecystojejunostomy&Gastro

Firing and Removing the Stapler

The stapler has been fired and removed. The staple line has been inspected for hemostasis and is being closed with a simple running suture.

Selecting and Affixing loop of jejunum

A loop of jejunum has been selected and affixed to the greater curvature of the stomach, above the gastroepiploic vessels, with two stay sutures. Two enterotomies have been made and the stapling device inserted.

Trocar Placement

Trocar placement for gastrojejunostomy is slightly different, in that trocar 2 is placed lower, to allow adequate working distance from the stomach. If you plan to do both procedures, use this trocar arrangement (rather than that in Fig. 36.1).

Inspecting the staple line for hemostasis

After the staple line has been inspected for hemostasis, the enterotomies are closed with a running suture. (Reprinted with permission from Bogen GL, Mancino AT, Scott-Conner CE. Laparoscopy for staging and palliation of gastrointestinal malignancy. Surg

Enterotomies

Stay sutures have been placed and tied. Two enterotomies have been made and the stapler is inserted into the two enterotomies. The bowel and gallbladder must be carefully positioned to fully utilize the entire length of the stapling device (by pulling the

Trocar Placement

Trocar placement for cholecystojejunostomy. If you plan to do a gastrojejunostomy as well, modify the trocar placement as shown later (Fig. 36.4). In each case, trocar placement must be individualized. A standard umbilical or subumbilical location for tro

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