Biliopancreatic Derivation With Duodenal Switch
| > Dissection | > Linear Gastrectomy | > Stage2 |
| > Stage3 | > Postoperative Management |
Linear Gastrectomy (sleeve resection)
Thelinear stapler-cutter device, blue load is introduced in and oriented so that the tip of the devascularised stomach lies between the jaws; the tip of the instrument is oriented towards and just to the left of the visible endings of the lesser curvature vessels. The greater curvature is pulled laterally and the device is fired.
Hence a pyramid shaped portion of stomach is partially detached from the stomach body and only attached to it at its base.
Before further firing, a 34 French plastic tube is introduced perorally by the anaesthetist and advanced into the stomach. The stapler is reopened without firing and repositioned so that it LOOSELY pushes the nasogastric tube against the lesser curvature . Hence the diameter of the tube will be at least 34 French. The instrument is fired, reloaded and the manoeuvre repeated.
Finally, after some five or six firings of the stapler, the greater curvature is completely detached from he stomach. It is pulled out of the patient’s abdominal wall, through the trocar hole in the left upper quadrant.
The gastric suture line is secured by the placement of Medium Large clips over the entire length. Alternatively a running suture of polypropylene 2/0 can be sewn in reinforcement of the staple line.