Tomas C Jakob, MD, Patricio Cal, Luciano Deluca, Fernandez Ezequiel. Hospital Churruca
Introduction: Least possible trauma, discomfort and loss of productivity are a common goal for surgeons and health care systems. Due to an exponential growth of Bariatric and Metabolic procedures, medical training and technological development are continuously improving, leading to defy the boundaries of minimally invasive procedures.
Objective: Perform safe changes in our standard technique to diminish operative trauma, pain and possible complications, mainly those related to the abdominal wall, subcutaneous fat and wound infections by reducing size and number of trocars performing an auto-static cheap liver retraction system.
Methods and Procedures: In this video we present a one anastomosis gastric bypass, performed in a 39 years old male patient with Type 2 Diabetes. BMI 34,11. To perform this metabolic procedure a 5mm 300 laparoscope, three 5mm trocars and one 12mm trocar were used. Auto-static liver retraction was built-up by attaching a polypropylene suture to the right crus and performing two trans-aponeurotic punctures through epigastrium with a Carter-Thomason® like trans-aponeurotic device to keep traction. His angle was dissected. Great omentum was mobilized and transected. Fat pad was resected. The posterior aspect of the stomach was approached through incisura angularis, in order to perform a long and narrow gastric pouch. Three cm linear cutting stapler was used with a gold load for gastric transversal section. A linear cutting stapler and a 27 Fr orogastric tube was used to complete pouch modeling. Dissection was completed till diaphragm was seen through the retrogastric space. Gastric remanent and gastric pouch were reinforced with a running polypropylene suture. Gastrotomy was performed with harmonic scalpel. Treitz angle was exposed and 2,5 mts small bowel has been counted to perform an ante-colic gastro-enteric anastomosis with a linear cutting stapler 3cm long, using a blue load. A 2-0 polypropylene one-layer running suture was used to close the anastomosis. A reinforcement anti-reflux stitch was placed and methylene blue test was performed. Petersen’s defect was closed and a Jackson Pratt drain was placed. Operatory time was 57 minutes. Patient was discharged in the first postoperative day.
Conclusions: Less operative trauma can be achieved by reducing size and numbers of trocars without jeopardizing patients safety. A cheap and less traumatic auto-static liver retractor can be built-up without extra risk. Abdominal wall morbidity was reduced without extra operatory time.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87181
Program Number: V217
Presentation Session: Thursday Video Loop (Non CME)
Presentation Type: VideoLoop
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