Biliopancreatic Derivation With Duodenal Switch
| > Dissection | > Linear Gastrectomy | > Stage2 |
| > Stage3 | > Postoperative Management |
In this procedure, the trocars are placed as for gastric bypass, but an additional 5 mm trocar is placed halfway between the pubis and the umbilicus.
Dissection
The stomach is lifted and the surgeon starts the devascularisation of the greater curvature with the help of the Ultracision _ device. Once the lesser sac has been entered, dissection is continued in a cephalad direction and the lower pole of the spleen is quickly reached.
At the level of the spleen’s lower pole, the peritoneal sheets are farther apart and the tissue in between is thicker and harbours tortuous vessels (the short gastrics) which must be coagulated separately, by using small bites of the Ultracision.
Eventually the dissection reaches the root of the left pillar of the hiatus.
When the upper pole of the fundus has been freed, the surgeon can lift the stomach anteriorly and to the right very much like turning a page of a book
After the liberation of the upper pole of the stomach, the remaining of the greater curvature must now be freed. The terminal branches of the gastro epiploic artery are thus coagulated one by one. As one closes in on the pylorus, the distal stomach is lifted anteriorly, hereby keeping the duodenum under traction. Eventually the gastroduodenal artery can be spotted and is left posteriorly. At that level, and not earlier, the duodenum is freed circumferentially and the right gastric artery is left unharmed. A vessel loop is looped around the duodenum at this very place and the dissection is terminated for now.