OPERATION: Laparoscopic Distal Gastrectomy (D1/D2)
ANAESTHETIC: General anaesthesia
FINDINGS: [Distal gastric tumour or gastric outlet obstruction. Distended stomach with food residue].
PROCEDURE:
3x 12mm, 2x 5mm ports. Primary port by open technique.
Endoflex retractor to left lobe of liver.
Gastrocolic ligament opened and divided under vision.
Right gastro-epiploic artery and vein clipped and divided.
Right gastric artery clipped and divided.
Left gastric artery and vein clipped and divided.
Duodenum divided with 60mm Echelon stapler.
Stomach divided with 60mm Echelon (Gold) x3-4.
Stapled gastrojejunostomy with 60mm Echelon (Blue). Anterior wall closed with 3-0 PDS.
50cm ante-colic Roux limb. Short biliopancreatic limb.
Jejunojejunostomy performed. Enterotomy closed.
Robinson drains placed to sub-hepatic space.
Methylene blue leak test with 250ml - no leak.
Specimen extracted via Pfannenstiel incision. 40ml levobupivacaine infiltrated.
CLOSURE: Staples to skin.
POST-OPERATIVE INSTRUCTIONS:
Nil by mouth 24 hours (sips for comfort). PICC line and TPN.
IV antibiotics x2 doses. VTE prophylaxis. IV proton pump inhibitor.
Chest physiotherapy. Early mobilisation. Leave drain in situ until further advice.