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Laparoscopic Gastric Bypass PDF Print E-mail

These photographs show how Dr. Callery performs a laparoscopic gastric bypass. There are almost as many variations on the way to perform a gastric bypass as there are surgeons who perform the surgery. The procedure shown here follows the basic steps outlined on the overview page, Gastric Bypass Surgery Overview. The order here is slightly different in as much as the roux limb is formed first and then the pouch is formed. Finally the roux limb is attached to the small upper gastric pouch.

This is a short limb gastric bypass. The roux limb is 75 cm long. The small proximal pouch is approximately 20 cc in volume. The roux limb is passed behind the transverse colon and in front of the larger distal gastric pouch so that it can be brought up to the small upper pouch.

Dr. Callery's Laparoscopic Gastric Bypass:

This figure shows the left upper abdomen. Note the liver, the lower part of the stomach located below the liver. Yellow material to the left of the liver and stomach is fatty tissue called omentum. Above the liver is the diaphragm.

 

 

This figure show the lower 80% of the stomach. The liver has been lifted to the left (patient's right). The stomach is about 8 to 10 inches long, top to bottom.

 

 

Here the spleen is visible between the live and the stomach. Upper portion of the stomach called the cardia is shown.

 

 

Creation of roux limb.

Identify the upper most portion of the small bowel, the jejunum.

 

 

Creation of roux limb. Divide Jejunum.

A stapler is placed across the jejunum to divide it. The stapler staples and cuts the bowel at the same time.
Details of gastric bypass operation for severe obesity as performed by Dr. Callery

 

 

Creation of roux limb.

Here are the two cut ends of the jejunum. Note the staple lines that close the ends. The distal part (the part on the right of the picture) will be brought forward 75cm to form the Roux limb.

 

 

Creation of roux limb.

Now the two pieces of bowel will be stapled together to form the "Y" in the roux Y construction.

The lower part of the jejunum has been advanced 75cm. Then the end of the upper bowel has been attached to the side of the part that was brought down. A hole has been made on each piece to accommodate the surgical stapler.

 

 

Creation of roux limb.

The surgical stapler has been inserted and will be fired. The stapler lays in twin rows of staples and cuts between them. This forms a connection between the pieces of bowel with a hole in the middle through which bowel contents may pass.

 

 

Creation of roux limb.

When the stapler is removed an opening remains. Here the surgeon is preparing to sew up the hole with a curved needle and slowly dissolving suture.

 

 

Creation of roux limb.

The opening is partially sewn closed.

 

 

Creation of roux limb.

The closure has been completed.

 

 

Creation of roux limb.

This photo shows the completed anastamosis. There is an opening in the fatty tissue that supports the intestine (the mesentary) that needs to be closed. (Arrow to be added.)

 

 

Creation of roux limb.

The opening in the small bowel mesentary has been closed so that internal hernias will not occur. (Arrow to be added.)

 

 

The small bowel has been passed up under the colon through the fatty tissue that supports the colon (colon mesentary). The fatty tissue has been carefully sutured to the intestinal wall to prevent internal hernias.

 

 

Creation of upper (proximal) pouch.

A finger retractor has been placed behind the stomach and can just be seen. A linear cutting stapler is poised to be placed across the upper stomach to begin to form the pouch. The finger retractor is a guide so that the staple will go in the right place.

 

 

Creation of upper pouch. Divide Stomach.

The stapler has been place part way across the upper stomach. When the stapler is fired it will lay down two parallel rows of staples and cut between them.
Details of gastric bypass operation for severe obesity as performed by Dr. Callery

 

 

Creation of upper pouch.

Now the stapler is being inserted vertically to perform the second cut.

 

 

Creation of upper pouch.

In order to line up the final cuts, a finger retractor has been inserted under the remaining stomach and brought out near the junction between the esophagus and stomach. The remaining cuts will follow the shaft of the retractor.

 

 

Creation of upper pouch.

The stomach transection has been completed and the small upper pouch lies to the left of the finger retractor.

 

 

Gastrojejunostomy (Attach jejunum to stomach pouch).

The upper pouch is being drawn down. A tube will be passed down the esophagus into the pouch. The corner of the pouch will be opened. The tube will be grasped and used to pull the anvil of a circular stapler down into the pouch.
Details of gastric bypass operation for severe obesity as performed by Dr. Callery.

 

 

Gastrojejunostomy.

The connecting rod of the anvil of the stapler has been pulled out of an opening in the pouch by the plastic tube seen on the right. A suture connects the tube and the rod. Suture will be cut and the tube and suture removed from the abdomen.

 

 

Gastrojejunostomy.

A purse string suture is sewn around the rod of the anvil to secure it in place in preparation for stapling.

 

 

Gastrojejunostomy.

The purse string suture is tied down.

 

 

In this pic one can compare the size of the new upper pouch (to the left) with the size of the remaining stomach!

 

 

Gastrojejunostomy.

The roux limb is being brought up from under the colon. It will pass in front of the stomach to be attached to the small upper pouch.

 

 

Gastrojejunostomy.

The body of the stapler is the large black round device seen on the right. It has been inserted into the abdomen and will be inserted into the opened end of the roux limb.

 

 

Gastrojejunostomy.

The stapler has been inserted into the end of the roux limb. A pointed rod has been extended out of the end of the stapler. The rod is barely visible as a silver spike off the corner of the roux limb. The spike will be inserted into the rod of the anvil.

 

 

Gastrojejunostomy.

The spike has been inserted into the rod of the anvil. Next the stapler will be closed and fired. The stapler creates a double circular row of staples that connects the upper pouch to the roux limb. The stapler also cuts a 1.1cm circular hole through the center of the ring of staples so that food can pass from the stomach into the roux limb.

 

 

Gastrojejunostomy.

Closure of the end of the roux limb. The body of the circular stapler has been removed. A linear cutting stapler is shown here. When the stapler is fired, the raw end of the bowel will be cut off and the bowel itself will be neatly closed with three rows of staples.

 

 

Completed Gastrojejunostomy.

Here you can see the finished gastro jejunal anastamosis. The pouch is attached to the roux limb. And the end of the roux limb has been closed as shown in the pic immediately above.
Details of gastric bypass operation for severe obesity as performed by Dr. Callery.

 

 

Gastrojejunostomy.

Shown here is the back side of the gastro jejunal anastamosis. Note the even circular row of staples.

 

 

A Jackson Pratt drain has been introduced into the abdomen. It is shown here next to the liver and sitting on fatty tissue called omentum.

 

 

The Jackson Pratt drain is inserted under the left lobe of the liver near the gastrojejunal anastamosis. If leakage should occur from one of the staple lines it would likely be removed by the drain.

 

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