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Keng-Hao LIU

Chang Gung Memorial Hospital
Taoyuan, Taiwan
MD
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Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome
Purpose:
The superior mesenteric artery (SMA) syndrome is a rare disease in which the third portion of the duodenum is compressed by the narrow space of the SMA and the aorta. Surgical treatment such as duodenojejunostomy (DJS) could resolve this problem. Here we report our experience of laparoscopic DJS with a video demonstration.

Materials and Methods:
This 18-year-old woman suffered from vomiting, abdominal distention and progressive weight loss during 6 months before admission. The abdominal discomfort usually occurred after meals and it could be alleviated by a decubitus position. Endoscopic exams revealed gastritis and reflux esophagitis. Computed tomography (CT) with contrast identified the distended stomach and the proximal duodenum obstructed by the SMA. Surgical treatment was advised after a complete preoperative survey, including a series of image survey, psychological evaluation and nutrition status. A three-port laparoscopic approach was used. After opening a small window through the mesocolon, a side-to-side DJS was created with a linear stapler and the common channel was closed with a hand-sewn suture.

Results:
There were no intraoperative complications. The laparoscopic DJS tooks 52 mins and blood loss was minimal. The nasogastric tube was removed on postoperative day 3 and she was discharged uneventfully on postoperative day 7. The postoperative upper GI series showed a smooth contrast passage from the DJS to the intestine and the patient gained 6 kg within 4 months after surgery.

Conclusion:
Laparoscopic DJS is a surgical option for SMA syndrome after conservative treatment failure. It is safe, feasible and provides the benefits of a minimally invasive approach.
Surgical intervention
3 years ago
1923 views
65 likes
0 comments
08:42
Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome
Purpose:
The superior mesenteric artery (SMA) syndrome is a rare disease in which the third portion of the duodenum is compressed by the narrow space of the SMA and the aorta. Surgical treatment such as duodenojejunostomy (DJS) could resolve this problem. Here we report our experience of laparoscopic DJS with a video demonstration.

Materials and Methods:
This 18-year-old woman suffered from vomiting, abdominal distention and progressive weight loss during 6 months before admission. The abdominal discomfort usually occurred after meals and it could be alleviated by a decubitus position. Endoscopic exams revealed gastritis and reflux esophagitis. Computed tomography (CT) with contrast identified the distended stomach and the proximal duodenum obstructed by the SMA. Surgical treatment was advised after a complete preoperative survey, including a series of image survey, psychological evaluation and nutrition status. A three-port laparoscopic approach was used. After opening a small window through the mesocolon, a side-to-side DJS was created with a linear stapler and the common channel was closed with a hand-sewn suture.

Results:
There were no intraoperative complications. The laparoscopic DJS tooks 52 mins and blood loss was minimal. The nasogastric tube was removed on postoperative day 3 and she was discharged uneventfully on postoperative day 7. The postoperative upper GI series showed a smooth contrast passage from the DJS to the intestine and the patient gained 6 kg within 4 months after surgery.

Conclusion:
Laparoscopic DJS is a surgical option for SMA syndrome after conservative treatment failure. It is safe, feasible and provides the benefits of a minimally invasive approach.
Robotic-assisted mini gastric bypass
Amongst bariatric procedures, mini gastric bypass has been described by Rutledge in 2001 with the objective of simplifying the gastric bypass technique (1). Mini gastric bypass only requires one anastomosis instead of 2 and should reduce complications related to the anastomosis at the foot of the loop in a conventional gastric bypass procedure. A few specificities should be pointed out. The gastric pouch is longer and more narrow. The landmark used to start the gastric division corresponds to the area separating the body of the stomach from the antrum at the level of the angulus. The biliary limb is also much longer and should reach 2cm in order to avoid the undiluted biliary fluid effects on the anastomosis. In this intervention, it is crucial to closue Petersen’s defect between the mounted loop and the transverse mesocolon. According to Himpens, this procedure could well reduce the incidence of hypoglycemias that might occur after a gastric bypass. This video outlines the different steps of the intervention. The use of a surgical robot allows to very easily perform a manual gastrojejunostomy.

(1). Rutledge, R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg 2001;11:276-80.
Surgical intervention
6 years ago
2130 views
47 likes
0 comments
15:41
Robotic-assisted mini gastric bypass
Amongst bariatric procedures, mini gastric bypass has been described by Rutledge in 2001 with the objective of simplifying the gastric bypass technique (1). Mini gastric bypass only requires one anastomosis instead of 2 and should reduce complications related to the anastomosis at the foot of the loop in a conventional gastric bypass procedure. A few specificities should be pointed out. The gastric pouch is longer and more narrow. The landmark used to start the gastric division corresponds to the area separating the body of the stomach from the antrum at the level of the angulus. The biliary limb is also much longer and should reach 2cm in order to avoid the undiluted biliary fluid effects on the anastomosis. In this intervention, it is crucial to closue Petersen’s defect between the mounted loop and the transverse mesocolon. According to Himpens, this procedure could well reduce the incidence of hypoglycemias that might occur after a gastric bypass. This video outlines the different steps of the intervention. The use of a surgical robot allows to very easily perform a manual gastrojejunostomy.

(1). Rutledge, R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg 2001;11:276-80.
Robot-assisted Roux-en-Y gastric bypass using Sonicision™ cordless ultrasonic dissection device
Gastric bypass is considered to be the gold standard in morbid obesity surgery.
If technical principles are well-established, there are several alternatives to apply them. Consequently, gastrojejunostomy can be performed in three different fashions: manual, linear, and circular. Manual anastomosis can be performed with the help of the robotic Da Vinci™ Surgical System. This robot is particularly suited for manual anastomosis thanks to the instruments’ articulated extremities. Operative steps that do not benefit from robotics are performed by means of conventional laparoscopy, and especially gastric pouch division. This video also demonstrates the combined use of ultrasonic wireless scissors developed by Covidien (i.e., the Sonicision™ cordless ultrasonic dissection device).
Surgical intervention
6 years ago
4782 views
4 likes
0 comments
17:20
Robot-assisted Roux-en-Y gastric bypass using Sonicision™ cordless ultrasonic dissection device
Gastric bypass is considered to be the gold standard in morbid obesity surgery.
If technical principles are well-established, there are several alternatives to apply them. Consequently, gastrojejunostomy can be performed in three different fashions: manual, linear, and circular. Manual anastomosis can be performed with the help of the robotic Da Vinci™ Surgical System. This robot is particularly suited for manual anastomosis thanks to the instruments’ articulated extremities. Operative steps that do not benefit from robotics are performed by means of conventional laparoscopy, and especially gastric pouch division. This video also demonstrates the combined use of ultrasonic wireless scissors developed by Covidien (i.e., the Sonicision™ cordless ultrasonic dissection device).