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Laparoscopic repair of a giant type III paraesophageal hernia with mesenteric-axial gastric volvulus
This video demonstrates a laparoscopic repair of a giant type III paraesophageal hernia with an associated mesenteric-axial gastric volvulus in a 61-year-old woman. Dissection of the hernia sac was difficult because the esophageal hiatus was not very enlarged and the overlying peritoneum was very thickened because of chronic hernia incarceration. Once the stomach was replaced into the peritoneal cavity, mediastinal mobilization of the esophagus up to the pulmonary vein was performed. After crural repair, a standard posterior fundoplication was performed, as the intra-abdominal esophageal length was adequate.
P Vorwald, M Posada, G Salcedo, R Restrepo, JR Torres
Surgical intervention
3 years ago
1738 views
54 likes
0 comments
13:44
Laparoscopic repair of a giant type III paraesophageal hernia with mesenteric-axial gastric volvulus
This video demonstrates a laparoscopic repair of a giant type III paraesophageal hernia with an associated mesenteric-axial gastric volvulus in a 61-year-old woman. Dissection of the hernia sac was difficult because the esophageal hiatus was not very enlarged and the overlying peritoneum was very thickened because of chronic hernia incarceration. Once the stomach was replaced into the peritoneal cavity, mediastinal mobilization of the esophagus up to the pulmonary vein was performed. After crural repair, a standard posterior fundoplication was performed, as the intra-abdominal esophageal length was adequate.
Small bowel volvulus over acute bowel invagination: laparoscopic management
Digestive angiodysplasia is a condition defined by an innate alteration of digestive wall vascular structures, which has been well-described since the development of endoscopy. Its cause is not well known and most occurrences are probably innate. Digestive angiodysplasias can be isolated or multiple. They most frequently affect the right colon, and more rarely the stomach, the duodenum and the small bowel. They are the most frequent cause of occult digestive hemorrhage (30 to 40% of cases) and can more rarely cause occlusive episodes through intestinal invagination, linked to a voluminous angiodysplasia lesion.
Here we describe the case of a girl treated for colonic angiodysplasia lesions. She was admitted to our intensive care unit for an occlusive syndrome. CT-scan helped to diagnose a small bowel invagination and decision is made to treat this patient laparoscopically.
More specifically, this 15-year-old girl has a history of strabismus repair in 2011 and right foot surgery for an arteriovenous angiodysplasia lesion. Angiodysplasia was diagnosed after an episode of abdominal pain and a rectorrhagia in 2010. Colonoscopy at this time allowed to find three lesions of 5 to 8mm in diameter. A yearly colonoscopy control is performed. The patient was admitted to the intensive care unit for an occlusive syndrome with abdominal pain. Abdominal ultrasonography suggested an invagination which was confirmed by injected CT-scan. Decision was made to perform a laparoscopic exploration for a disinvagination or a bowel resection.
J Leroy, L Marx, D Mutter, J Marescaux
Surgical intervention
5 years ago
1439 views
19 likes
0 comments
07:41
Small bowel volvulus over acute bowel invagination: laparoscopic management
Digestive angiodysplasia is a condition defined by an innate alteration of digestive wall vascular structures, which has been well-described since the development of endoscopy. Its cause is not well known and most occurrences are probably innate. Digestive angiodysplasias can be isolated or multiple. They most frequently affect the right colon, and more rarely the stomach, the duodenum and the small bowel. They are the most frequent cause of occult digestive hemorrhage (30 to 40% of cases) and can more rarely cause occlusive episodes through intestinal invagination, linked to a voluminous angiodysplasia lesion.
Here we describe the case of a girl treated for colonic angiodysplasia lesions. She was admitted to our intensive care unit for an occlusive syndrome. CT-scan helped to diagnose a small bowel invagination and decision is made to treat this patient laparoscopically.
More specifically, this 15-year-old girl has a history of strabismus repair in 2011 and right foot surgery for an arteriovenous angiodysplasia lesion. Angiodysplasia was diagnosed after an episode of abdominal pain and a rectorrhagia in 2010. Colonoscopy at this time allowed to find three lesions of 5 to 8mm in diameter. A yearly colonoscopy control is performed. The patient was admitted to the intensive care unit for an occlusive syndrome with abdominal pain. Abdominal ultrasonography suggested an invagination which was confirmed by injected CT-scan. Decision was made to perform a laparoscopic exploration for a disinvagination or a bowel resection.
Laparoscopic Tanner’s gastropexy for acute gastric volvulus
Acute gastric volvulus is a rare clinical entity defined as an abnormal rotation of the stomach of more than 180 degrees, creating a closed loop obstruction that can result in incarceration and/or strangulation. The most common causes of gastric volvulus in adults are diaphragmatic defects such as paraesophageal hernias. Historically, mortality rates of 30-50% have been reported for acute volvulus, with the major cause of death being strangulation, which can lead to necrosis and perforation. Emergent surgical intervention is indicated for acute gastric volvulus. The laparoscopic treatment requires considerable experience but it has the potential to decrease the morbidity associated with open procedures. In February 2009, a case of an organo-axial gastric volvulus with a giant hiatal hernia was published in WeBSurg. We would like to take advantage of this to present a case with a mesentero-axial type marking the difference of the pathophysiology.
J Torres Bermúdez, S del Valle Ruiz , J Lopez Espejo, G Sánchez de la Villa
Surgical intervention
9 years ago
3811 views
41 likes
0 comments
12:27
Laparoscopic Tanner’s gastropexy for acute gastric volvulus
Acute gastric volvulus is a rare clinical entity defined as an abnormal rotation of the stomach of more than 180 degrees, creating a closed loop obstruction that can result in incarceration and/or strangulation. The most common causes of gastric volvulus in adults are diaphragmatic defects such as paraesophageal hernias. Historically, mortality rates of 30-50% have been reported for acute volvulus, with the major cause of death being strangulation, which can lead to necrosis and perforation. Emergent surgical intervention is indicated for acute gastric volvulus. The laparoscopic treatment requires considerable experience but it has the potential to decrease the morbidity associated with open procedures. In February 2009, a case of an organo-axial gastric volvulus with a giant hiatal hernia was published in WeBSurg. We would like to take advantage of this to present a case with a mesentero-axial type marking the difference of the pathophysiology.
Giant hiatal hernia: acute presentation with gastric volvulus
Hiatal hernia is a common disorder of the digestive tract. Most patients are elderly and with significant co-morbidities. Historically, the surgical repair of paraesophageal hernias (PHH) has been advocated regardless of the presence of symptoms. In fact, despite patients being symptom-free, the development of potentially life-threatening complications such as obstruction, acute dilatation, perforation, or bleeding of the stomach mucosa, is well-known and has proven to be fatal in 27% of cases. Nevertheless, patients with asymptomatic PHH are likely to develop symptoms needing emergency surgery in only 1.16% of cases with a 5.4% mortality rate. Recently, several authors have questioned the indication for repair in asymptomatic patients and prefer to monitor asymptomatic or minimally symptomatic PHH by ‘watchful waiting’. Our current practice is to operate only in the case symptoms or complications. The laparoscopic repair of PHH is certainly technically challenging. It requires considerable experience with minimally invasive surgery of the foregut, and a complete understanding of esophageal pathophysiology. The basic principles of surgical repair are the reduction of herniated stomach and distal esophagus into the abdominal cavity with tension-free repositioning of 2cm of lower esophagus in a subphrenic position, complete excision of the peritoneal hernia sac from the mediastinum and the repair of the diaphragmatic hiatus.
This is the case of a woman admitted to the emergency room for complete acute dysphagia associated with type IV paraesophageal hernia. The preoperative work-up (CT-scan, upper GI series) showed the migration of the stomach, left transverse colon and omentum into the chest.
B Dallemagne, S Perretta, J Marescaux
Surgical intervention
10 years ago
2660 views
77 likes
0 comments
15:02
Giant hiatal hernia: acute presentation with gastric volvulus
Hiatal hernia is a common disorder of the digestive tract. Most patients are elderly and with significant co-morbidities. Historically, the surgical repair of paraesophageal hernias (PHH) has been advocated regardless of the presence of symptoms. In fact, despite patients being symptom-free, the development of potentially life-threatening complications such as obstruction, acute dilatation, perforation, or bleeding of the stomach mucosa, is well-known and has proven to be fatal in 27% of cases. Nevertheless, patients with asymptomatic PHH are likely to develop symptoms needing emergency surgery in only 1.16% of cases with a 5.4% mortality rate. Recently, several authors have questioned the indication for repair in asymptomatic patients and prefer to monitor asymptomatic or minimally symptomatic PHH by ‘watchful waiting’. Our current practice is to operate only in the case symptoms or complications. The laparoscopic repair of PHH is certainly technically challenging. It requires considerable experience with minimally invasive surgery of the foregut, and a complete understanding of esophageal pathophysiology. The basic principles of surgical repair are the reduction of herniated stomach and distal esophagus into the abdominal cavity with tension-free repositioning of 2cm of lower esophagus in a subphrenic position, complete excision of the peritoneal hernia sac from the mediastinum and the repair of the diaphragmatic hiatus.
This is the case of a woman admitted to the emergency room for complete acute dysphagia associated with type IV paraesophageal hernia. The preoperative work-up (CT-scan, upper GI series) showed the migration of the stomach, left transverse colon and omentum into the chest.
Laparoscopic Frey's procedure with management of intraoperative complication
This is the case of a 61-year-old lady presenting with recurrent abdominal intractable pain she has been suffering from for the last 7 years. Multi-slice CT (MSCT) revealed pancreatic calcifications from 1 to 5-8mm and dilatation of the main pancreatic duct in the body of the pancreas up to 4mm. The patient underwent laparoscopic local resection of the pancreatic head combined with a longitudinal Roux-en-Y pancreaticojejunostomy, a technique known as Frey's procedure. It is recognized as an effective therapeutic option for the surgical treatment of patients with persistent pain caused by chronic pancreatitis.
After fashioning the posterior wall of the pancreaticojejunal anastomosis, we faced an intraoperative complication such as a volvulus of the Roux limb causing serious ischemia of the limb. We were forced to remove all previous sutures in order to untwist the Roux limb. The pancreaticojejunostomy was started anew afterwards.
The purpose of this video is to demonstrate that Frey's procedure can be performed in a minimally invasive fashion, which provides all the well-known advantages of this approach. We demonstrate that even a serious intraoperative complication such as a volvulus of the Roux limb can be managed without conversion. Our center has an experience of over 30 laparoscopic Frey's procedures. However, this is the first case where we encountered this complication and we believe this is an experience worth sharing.
Yet, we would like to underline that this approach should be used by highly skilled minimally invasive surgeons with an experience in intracorporeal suturing, which is the most challenging stage in Frey's procedure.
P Agami, A Andrianov, V Shchadrova, M Baychorov, R Izrailov
Surgical intervention
4 months ago
4652 views
17 likes
3 comments
12:28
Laparoscopic Frey's procedure with management of intraoperative complication
This is the case of a 61-year-old lady presenting with recurrent abdominal intractable pain she has been suffering from for the last 7 years. Multi-slice CT (MSCT) revealed pancreatic calcifications from 1 to 5-8mm and dilatation of the main pancreatic duct in the body of the pancreas up to 4mm. The patient underwent laparoscopic local resection of the pancreatic head combined with a longitudinal Roux-en-Y pancreaticojejunostomy, a technique known as Frey's procedure. It is recognized as an effective therapeutic option for the surgical treatment of patients with persistent pain caused by chronic pancreatitis.
After fashioning the posterior wall of the pancreaticojejunal anastomosis, we faced an intraoperative complication such as a volvulus of the Roux limb causing serious ischemia of the limb. We were forced to remove all previous sutures in order to untwist the Roux limb. The pancreaticojejunostomy was started anew afterwards.
The purpose of this video is to demonstrate that Frey's procedure can be performed in a minimally invasive fashion, which provides all the well-known advantages of this approach. We demonstrate that even a serious intraoperative complication such as a volvulus of the Roux limb can be managed without conversion. Our center has an experience of over 30 laparoscopic Frey's procedures. However, this is the first case where we encountered this complication and we believe this is an experience worth sharing.
Yet, we would like to underline that this approach should be used by highly skilled minimally invasive surgeons with an experience in intracorporeal suturing, which is the most challenging stage in Frey's procedure.
Laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
Morbid obesity has reached epidemic proportions. Biliopancreatic diversion with duodenal switch (BPD-DS) is the most effective bariatric surgery procedure for weight loss. This procedure was first described by Scopinaro in 1979. It consisted of a horizontal gastrectomy, a transection of the bowel halfway from the ligament of Treitz and the ileocecal junction, and a Roux-en-Y reconstruction with a 50cm common channel. This was later modified: the duodenal switch was added and the gastrectomy was performed in a vertical sleeve fashion, thereby preserving the pylorus and increasing the common channel to 100cm. This modification greatly reduced the incidence of marginal ulceration, dumping, and nutritional deficiencies. However, this operation is still uncommon due to the perceived technical difficulty and risk of nutritional morbidity. This video demonstrates a standardized technique for this complex procedure.
RC Pullatt
Surgical intervention
1 day ago
41 views
0 likes
0 comments
13:00
Laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
Morbid obesity has reached epidemic proportions. Biliopancreatic diversion with duodenal switch (BPD-DS) is the most effective bariatric surgery procedure for weight loss. This procedure was first described by Scopinaro in 1979. It consisted of a horizontal gastrectomy, a transection of the bowel halfway from the ligament of Treitz and the ileocecal junction, and a Roux-en-Y reconstruction with a 50cm common channel. This was later modified: the duodenal switch was added and the gastrectomy was performed in a vertical sleeve fashion, thereby preserving the pylorus and increasing the common channel to 100cm. This modification greatly reduced the incidence of marginal ulceration, dumping, and nutritional deficiencies. However, this operation is still uncommon due to the perceived technical difficulty and risk of nutritional morbidity. This video demonstrates a standardized technique for this complex procedure.
Relaxing incision for crural repair in type III paraesophageal hernia
This video shows the laparoscopic repair of a large type III paraesophageal hernia in a 55-year-old woman. After dissection of the hernia sac, partial resection is performed. Very high intramediastinal dissection of the esophagus is performed, taking special care not to injure the posterior and anterior vagal trunk. First, as the hiatal defect is very large, a right relaxing incision is performed. The crural repair is performed by interrupted Ethibond® 2/0 stitches buttressed with a polypropylene mesh. Finally, the diaphragmatic defect is covered with a non-reabsorbable mesh (Physiomesh™) and a 180-degree posterior fundoplication is performed.
P Vorwald, G Salcedo, M Posada, C Lévano Linares, ML Sánchez de Molina, R Restrepo, C Ferrero
Surgical intervention
3 years ago
2095 views
79 likes
0 comments
09:13
Relaxing incision for crural repair in type III paraesophageal hernia
This video shows the laparoscopic repair of a large type III paraesophageal hernia in a 55-year-old woman. After dissection of the hernia sac, partial resection is performed. Very high intramediastinal dissection of the esophagus is performed, taking special care not to injure the posterior and anterior vagal trunk. First, as the hiatal defect is very large, a right relaxing incision is performed. The crural repair is performed by interrupted Ethibond® 2/0 stitches buttressed with a polypropylene mesh. Finally, the diaphragmatic defect is covered with a non-reabsorbable mesh (Physiomesh™) and a 180-degree posterior fundoplication is performed.
Acute small bowel obstruction two months after laparoscopic rectal prolapse surgery: laparoscopic management
Acute small bowel obstruction (SBO) is an ever-increasing clinical problem. In this video, the authors demonstrate the laparoscopic management of acute small bowel obstruction. Its successful management depends on a comprehensive knowledge of the etiology and pathophysiology of obstruction, familiarity with imaging methods, good clinical judgment, and sound technical skills. The adoption of laparoscopy in the treatment of SBO has been slow because of concerns for iatrogenic bowel injury and working space issues related to bowel distension.
In this film, the authors demonstrate that it is essential to rapidly manage the patient after the first acute attack.
Although there is an inherent appeal for laparoscopy in its potential to minimize short- and long-term wound complications and perioperative laparotomy-related morbidity and to theoretically induce fewer subsequent adhesions than a traditional laparotomy incision would.

Small bowel obstruction is a pathology commonly found in the current practice of surgical emergencies. The main cause stems from surgical history with a variable onset of symptoms. The introduction of laparoscopic surgery helped to slightly reduce the number of patients presenting with occlusive syndromes. The rapid management of occlusive patients is one of the keys to success. Consequently, once diagnosis has been evoked, imaging studies must be performed, and especially CT-scan, in order to determine the type of obstruction, its mechanism and its severity. After work-up, either a conservative medical treatment or surgery will be decided upon.
L Marx, J Leroy, J Marescaux
Surgical intervention
6 years ago
2981 views
20 likes
0 comments
04:19
Acute small bowel obstruction two months after laparoscopic rectal prolapse surgery: laparoscopic management
Acute small bowel obstruction (SBO) is an ever-increasing clinical problem. In this video, the authors demonstrate the laparoscopic management of acute small bowel obstruction. Its successful management depends on a comprehensive knowledge of the etiology and pathophysiology of obstruction, familiarity with imaging methods, good clinical judgment, and sound technical skills. The adoption of laparoscopy in the treatment of SBO has been slow because of concerns for iatrogenic bowel injury and working space issues related to bowel distension.
In this film, the authors demonstrate that it is essential to rapidly manage the patient after the first acute attack.
Although there is an inherent appeal for laparoscopy in its potential to minimize short- and long-term wound complications and perioperative laparotomy-related morbidity and to theoretically induce fewer subsequent adhesions than a traditional laparotomy incision would.

Small bowel obstruction is a pathology commonly found in the current practice of surgical emergencies. The main cause stems from surgical history with a variable onset of symptoms. The introduction of laparoscopic surgery helped to slightly reduce the number of patients presenting with occlusive syndromes. The rapid management of occlusive patients is one of the keys to success. Consequently, once diagnosis has been evoked, imaging studies must be performed, and especially CT-scan, in order to determine the type of obstruction, its mechanism and its severity. After work-up, either a conservative medical treatment or surgery will be decided upon.
Laparoscopic repair of giant type 4 paraesophageal hernia
Type 4 giant hiatal hernias are not common. The stomach is herniated, as well as viscera in the mediastinum, colon, spleen, and even sometimes in the pancreas. Repair is challenging for different reasons. This type of hernia is frequent in older and fragile patients. Reduction of the sac from the mediastinum is mandatory and must be carried out following stepwise and precise dissection rules: it has to be done outside of the sac, in an anatomical cleavage plane. Crural repair is challenging and must be tailored on the quality of the diaphragmatic musculature and size of the orifice. Anti-reflux repair must be performed as well. The laparoscopic approach has radically improved the clinical outcome of this procedure in old patients.
B Dallemagne, E Marzano, S Perretta, J Marescaux
Surgical intervention
7 years ago
4816 views
83 likes
0 comments
21:43
Laparoscopic repair of giant type 4 paraesophageal hernia
Type 4 giant hiatal hernias are not common. The stomach is herniated, as well as viscera in the mediastinum, colon, spleen, and even sometimes in the pancreas. Repair is challenging for different reasons. This type of hernia is frequent in older and fragile patients. Reduction of the sac from the mediastinum is mandatory and must be carried out following stepwise and precise dissection rules: it has to be done outside of the sac, in an anatomical cleavage plane. Crural repair is challenging and must be tailored on the quality of the diaphragmatic musculature and size of the orifice. Anti-reflux repair must be performed as well. The laparoscopic approach has radically improved the clinical outcome of this procedure in old patients.
Paraesophageal hernias and controversies
There are several advanced situations in antireflux surgery: these include giant hiatal hernias (PEH), the short esophagus and the use of meshes to minimize recurrences.
PEH is a disease of the diaphragm more than one of the esophagus, recurrence rates at 5 to 10 years are very high (>50%) due to intrinsic defects of the connective tissue of the diaphragm. Keys to surgical repair include: reduction of the mediastinal hernia sac, extensive mobilization of the esophagus to bring the GE junction into the abdomen, reinforced repair of the diaphragm. Gastropexy can occasionally be a useful adjunct. Reinforced repair of the diaphragm can involve pledgets, relaxing incisions, or mesh. Mesh remains a controversial subject. The lowest reherniation rates in the literature are with plastic mesh but such a mesh is associated with esophageal erosions. The existence of the short esophagus is controversial, most agree it exists 3 to 5% of the time. The optimal treatment is extensive mediastinal mobilization and, if that fails, to perform a laparoscopic Collis gastroplasty. There are several techniques for Collis including transthoracic or wedge gastroplasty. All result in good functional results but the ectopic gastric mucosa that results often secretes acid and requires the patient to stay on anti-acid medication.
LL Swanström
Lecture
7 years ago
4751 views
29 likes
0 comments
42:08
Paraesophageal hernias and controversies
There are several advanced situations in antireflux surgery: these include giant hiatal hernias (PEH), the short esophagus and the use of meshes to minimize recurrences.
PEH is a disease of the diaphragm more than one of the esophagus, recurrence rates at 5 to 10 years are very high (>50%) due to intrinsic defects of the connective tissue of the diaphragm. Keys to surgical repair include: reduction of the mediastinal hernia sac, extensive mobilization of the esophagus to bring the GE junction into the abdomen, reinforced repair of the diaphragm. Gastropexy can occasionally be a useful adjunct. Reinforced repair of the diaphragm can involve pledgets, relaxing incisions, or mesh. Mesh remains a controversial subject. The lowest reherniation rates in the literature are with plastic mesh but such a mesh is associated with esophageal erosions. The existence of the short esophagus is controversial, most agree it exists 3 to 5% of the time. The optimal treatment is extensive mediastinal mobilization and, if that fails, to perform a laparoscopic Collis gastroplasty. There are several techniques for Collis including transthoracic or wedge gastroplasty. All result in good functional results but the ectopic gastric mucosa that results often secretes acid and requires the patient to stay on anti-acid medication.
Laparoscopic repair of post-traumatic diaphragmatic hernia with mesh insertion
Traumatic injuries of the diaphragm are rare (0.8%-5.8% of all blunt trauma). Early diagnosis is difficult, and many reports have described delayed presentation of diaphragmatic hernia with subsequent significant morbidity and mortality.

We report a case of an acute diaphragmatic hernia in a 47-year-old male presenting 4 years after the traumatic episode (significant fall from a ladder). The patient was admitted to the emergency department with severe vomiting and dehydration. Once the patient was stabilised with fluid resuscitation and nasogastric tube aspiration, an urgent CT-scan was performed. This demonstrated a large defect within the left hemi-diaphragm, associated with herniation of both the antrum and body of the stomach, into the thoracic cavity.
At laparoscopy, a large rupture of the left hemi-diaphragm with herniation and rotation of the stomach was confirmed. The hernia was reduced laparoscopically, and the defect repaired with interrupted, non-absorbable polyester sutures (Ethibond 2/0, Ethicon) and a composite mesh (Proceed™, Ethicon). The patient made an uneventful recovery.
Emergency repair of the diaphragm is usually performed via a thoracotomy or/and laparotomy. In our experience, if the patient is haemodynamically stable and major organ injuries have been excluded, a laparoscopic approach can be considered safe and effective.
A Rotundo, T Knowles, S Kadirkamanathan, M Harvey
Surgical intervention
7 years ago
4574 views
46 likes
0 comments
10:21
Laparoscopic repair of post-traumatic diaphragmatic hernia with mesh insertion
Traumatic injuries of the diaphragm are rare (0.8%-5.8% of all blunt trauma). Early diagnosis is difficult, and many reports have described delayed presentation of diaphragmatic hernia with subsequent significant morbidity and mortality.

We report a case of an acute diaphragmatic hernia in a 47-year-old male presenting 4 years after the traumatic episode (significant fall from a ladder). The patient was admitted to the emergency department with severe vomiting and dehydration. Once the patient was stabilised with fluid resuscitation and nasogastric tube aspiration, an urgent CT-scan was performed. This demonstrated a large defect within the left hemi-diaphragm, associated with herniation of both the antrum and body of the stomach, into the thoracic cavity.
At laparoscopy, a large rupture of the left hemi-diaphragm with herniation and rotation of the stomach was confirmed. The hernia was reduced laparoscopically, and the defect repaired with interrupted, non-absorbable polyester sutures (Ethibond 2/0, Ethicon) and a composite mesh (Proceed™, Ethicon). The patient made an uneventful recovery.
Emergency repair of the diaphragm is usually performed via a thoracotomy or/and laparotomy. In our experience, if the patient is haemodynamically stable and major organ injuries have been excluded, a laparoscopic approach can be considered safe and effective.
Technique: laparoscopic distal gastrectomy
The description of the technique of laparoscopic distal gastrectomy covers all aspects of the surgical procedure used for the management of chronic gastric ulcers.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: surgical procedure, exploration, dissection of greater curvature, resection of the antrum, gastroduodenal anastomosis, Billroth II anastomosis, complications, intraoperative complications, postoperative complications, functional complications.
Consequently, this operating technique is well standardized for the management of this condition.
D Mutter
Operative technique
18 years ago
3760 views
124 likes
0 comments
Technique: laparoscopic distal gastrectomy
The description of the technique of laparoscopic distal gastrectomy covers all aspects of the surgical procedure used for the management of chronic gastric ulcers.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: surgical procedure, exploration, dissection of greater curvature, resection of the antrum, gastroduodenal anastomosis, Billroth II anastomosis, complications, intraoperative complications, postoperative complications, functional complications.
Consequently, this operating technique is well standardized for the management of this condition.