By Karl Miller
The Operation Primer offers first-class photographic step by step suggestions to the surgery. it's been produced to explain the operation within the least difficult demeanour attainable with no over-simplifying. The middle of the Operation Primer is the part on Nodal issues, the place the surgical key steps are defined intimately. This surgical consultant e-book presents crucial reference fabric to surgeons wishing to replace their wisdom during this particular zone
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Extra info for Laparoscopic Gastric Banding (Operation Primer, 8)
Alternative: If the gastric band fits properly on the gastro-esophageal junction and cannot slip, perform only the first safety suture (fundus to left crus of diaphragm) and no gastro-gastric sutures. 50 Placing the first safety suture Left crus of the diaphragm Fundus Needle holder Placing the second safety suture First safety suture Pouch SAGB Gastric Band Fundus Placing the third safety suture Liver First safety suture Needle holder Fundus Pouch 51 IV Exploring the abdominal cavity Identifying the anatomical landmarks NODAL POINTS 10 T1 T2 T3 T4 Testing the stomach for leaks Scope Liver retracting device Atraumatic grasping forceps Atraumatic grasping forceps Dissecting the pars flaccida Dissecting the angle of His Introducing the gastric band Creating the retrocardial tunnel and connecting the gastric band with the Goldfinger™ Positioning the gastric band Closing the gastric band – SAGB Gastric Band – Gastric calibration tube – Bowl with 20 ml methylene blue solution (5 ml methylene blue 1 % with 15 ml saline solution) – 10-ml syringe T3 T4 T2 T1 Placing the safety sutures Testing the stomach for leaks Inspecting the operating field and removing the trocars Attaching and fixing the port system – Velocity™ Note that a methylene blue test is a security check and does not guarantee that the stomach has not been injured!
PLACING THE TROCAR FOR THE SCOPE Alternative: When using the Endopath® Veress Needle Ultra (Ethicon Endo-Surgery), the valve is opened to perform the injection test, whereupon the NaCl solution is released into the abdominal cavity if the Veress needle is in the correct position. In addition, the red marker ball drops down, indicating that NaCl solution is being released into the abdominal cavity. Rotation test Carefully rotate the slightly tilted needle inside the abdominal cavity. If the needle can be rotated freely, adhesions in the close proximity are unlikely.
75, band complications). Place two additional sutures anteriorly between the fundus and the pouch in order to surround the band completely by a cuff of stomach wall. It is important to sew the complete seromuscular layer of the stomach wall. When placing the safety sutures take care to sew the complete seromuscular layer of the stomach wall! Make sure that the band fastening remains freely accessible for later revisions and that the cuff is not too tight and will allow subsequent unrestricted inflation of the balloon during adjustment of the gastric band.