OPERATION: Laparoscopic Roux-en-Y Gastric Bypass
ANAESTHETIC: General anaesthesia
INDICATION: Morbid obesity
POSITION: Legs apart, first surgeon between legs.
FINDINGS: Left lobe of liver reduced to normal size.
PROCEDURE:
Pneumoperitoneum via Veress needle and 12mm Visiport - no complications.
5 ports: 3x 12mm, 1x 5mm, 1x 5mm for Nathanson liver retractor.
Division of Belsey's fat pad. Omentum divided. Small bowel length checked.
Approximately 20cc gastric pouch formed with EndoGIA 45 (purple) + 60 (gold) x2.
Ante-colic gastrojejunostomy with EndoGIA 45 (gold) and oversewing with 2-0 PDS V-Lok x2. BP limb 50cm.
150cm alimentary limb measured.
Side-to-side jejunojejunostomy with EndoGIA 45 (gold) + 2-0 V-Lok PDS oversewn.
Methylene blue test: no leak at jejunojejunostomy. Gastrojejunostomy tested - no leak.
Intervening jejunum disconnected with EndoGIA 60 (gold), leaving 1cm hockey stick.
Mesenteric and Petersen's defects closed with 2-0 Ethibond.
CLOSURE:
Thorough haemostasis, irrigation and aspiration.
Ports removed under vision. 3-0 Monocryl to skin.
BLOOD LOSS: Minimal (less than 100ml).
POST-OPERATIVE INSTRUCTIONS:
Bariatric protocol. Omeprazole twice daily from this evening.
Dalteparin first dose this evening. Enhanced recovery protocol.