COMPREHENSIVE ATLAS OF SURGICAL TECHNIQUES
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The stomach will be tunnelized along the smaller curvature.
The peritoneum in front of the esophagus is transversally opened. This maneuver leads to the left crus of the diaphragm and gastric mesogastrum. It elevates the cardia region to facilite the final step of the future stapling.
The greater omentum is separated from the stomach starting 8cm proximal to the pylorus to the cardia. This preparation is performed using the ultracision and stays in contact with the stomach thus respecting the gastroepiploic arcade.
Gastric preparation completed.
The anesthetist puts a 36-French gastric tube. This one is placed along the smaller curvature. Eight cm proximal to the pylorus the linear 60mm endostapler catches the greater curvature and carries out the first stapling. During this maneuver the anesthetist is asked to maintain a slight pressure on the tube to prevent its eventual retraction during the stapling.
Second endostapling. The same pressure is kept by the anesthetist. After this maneuver the anesthetist is asked to gently move to and fro the tube to make sure that the tunnel is not too tight or the stapling has caught the tube.
Before carrying the next stapling out the distal stomach is balanced on the right over the already performed tunnel to verify its vascularity and its adaptation to the tube.
The last stapling can be foreseen when the posterior jaw of the device is visible after closing it.
The staple line is verified, small hemorrhages are controled and the methylene blue test is done paying a particular attention to the higher part of the separation.
The stomach is retrieved by enlarging one of the left incision to 4 cm.
A soft low negative pressure drain is left along the stapling.