Patricio Cal, MD, Luciano Deluca, MD, Tomas Jakob, MD, Diego Lonardi, MD, Ezequiel Fernandez, MD. Hospital Churruca
38-year-old woman, BMI 45.2, with insulin dependent type 2 diabetes. Multiple hyperplastic polyps were diagnosed in the preop endoscopy. Decision was taken to perform a robotic single anastomosis gastric bypass with total gastrectomy of the remnant.
After setup of the Da Vinci Si robotic system, liver retraction was achieved with a polypropylene stich passed through the right crura and retrieved with a fascia closure needle. The angle of His was dissected, and the omentum was transected.
A long and thin gastric pouch was created starting below the incisura angularis and calibrated over a 27 Fr Bougie. A golden load was used for the first stapling followed by blue loads.
Using the vessel sealer gastrectomy of the remnant was carried on. The duodenum was transected with a blue load.
A running suture was used to reinforce the stapling line of the pouch.
After identifying the angle of Treitz, 200 cm of jejunum were measured.
An anti reflux mechanism was created, as described by Carbajo, by a 10 cm long side to side suture of the jejunum to the gastric pouch.
Afterwards, a manual gastrojejunostomy was performed using a running PDS suture on a posterior and anterior layer. The bougie was advanced after the posterior layer as a protection against strictures. A blue methylene leak test was performed.
A drain posterior to the the GJ anastomosis to the left suphrenic space was left in place, and the resected stomach was removed.
Total surgical time was 2 hours and 25 minutes. Patient was discharged after 24 hours.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88204
Program Number: V236
Presentation Session: Thursday Video Loop (Non CME)
Presentation Type: VideoLoop