Biliopancreatic Derivation With Duodenal Switch
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Stage 3
The surgeon stands again between the patient’s legs. The patient is put in a horizontal position. The angle of Treitz is located and the first jejunal loops are grasped and runned down. Finally, the already performed anastomosis is reached, together with the cut end of bowel. The omentum can now be slit longitudinally by the Ultracision _ device.
The duodenum is transected by the linear staple, blue load at the level of the loop.The transected small bowel is advanced to the transected proximal art of the duodenum and a large bite stitch Polypropylene 2/0 is driven through the angle of this duodenal staple line just distal to the right gastric artery. A full layer of duodenal wall is taken and the needle is then driven through the antimesenteric edge of the small bowel. A running suture is performed until eventually, the entire staple line is incorporated and joined to the antimesenteric border of the small bowel. An opening is made by the hook cautery on both sides of this suture line and the large bore gastric tube, which is still just proximal the pylorus in the gastric lumen is advanced by the anesthesiologist and advanced out of the duodenum and into the small bowel.. A second suture line is now placed in a similar fashion as the posterior one. The large bore gastric tube is pulled back by the anaesthetist until it sits again in he stomach and the integrity of the suture is checked by the immersion-insufflation technique.
The abdomen is rinced and a Penrose drain is placed in close vicinity of both anastomosis. The pneumoperitoneum is released and the skin closed with subcuticular stitches.