Eugene Wang, MD, Timothy Shope, MD. Medstar Washington Hospital Center
This video demonstrates our method of closing the mesenteric defects after a Roux-en-Y gastric bypass. In common schematics representing mesenteric defects after Roux en Y gastric bypasses, the alimentary limb is on the patient’s right side, and the biliopancreatic limb is on the left side, with the two mesenteric defects relatively distant from each other, and requiring two separate sutures for closure. However, in our method of closing the mesenteric defects after Roux en Y gastric bypasses, the alimentary limb is on the patient’s left side, and the biliopancreatic limb is on the right side, the opposite of the common schematics available in the literature. This positions both mesenteric defects close together for re-approximation with one suture.
With our ante-colic, ante-gastric Roux-en-Y gastric bypass, there are two mesenteric defects to close: 1) the defect between the mesentery of the proximal alimentary limb and transverse mesocolon near ligament of Treitz, and 2) the defect between the cut edge of the biliopancreatic limb with the proximal alimentary limb mesentery.
We close both of these defects with one suture. Our silk suture first goes through a superficial bite of the proximal alimentary limb mesentery, then of the transverse colon mesentery near ligament of Treitz, then of the bilio-pancreatic limb mesentery near the staple line, and finally back through the proximal alimentary limb mesentery. This effectively closes both the mesenteric defect between 1) the jejunal mesentery and transverse colon mesentery, and 2) the mesenteric defect at the jejuno-jejunostomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84738
Program Number: V195
Presentation Session: Wednesday Video Loop (Non CME)
Presentation Type: VideoLoop