Editing RYGB (section)

== '''Technique''' ==

* Lithotomy, reverse     Trendelenburg
* Same ports as for sleeve     gastrectomy
* Nathanson retractor
* Create pouch
** Clear angle of His by      dividing short gastrics from spleen
** Enter lesser sac 7cm distal      to GOJ, along lesser curvature
** Staple transversely across      stomach at this level
* Plan reconstruction
** Retract omentum and      transverse colon cephalad - visualise ligament of Treitz, look for IMV
** Follow jejunum distally for      50-150cm (100cm at Austin)
** Staple across bowel at this      point, with assistant holding on to proximal limb
* Create jejunojejunal     anastomosis
** Follow the common channel      (distal limb) 100cm distally
** Stay suture this piece of      bowel to the end of BP limb, which assistant is still holding
** Create a stapled      side-to-side anastomosis, suturing the stapler holes again in      purse-string fashion
* Create gastrojejunal     anastomosis
** Take the proximal end of      common channel (free end) up to stomach, most likely antecolic
** Place bougie down to distal      end of pouch
** Create holes in both pouch      and jejunum to admit stapler, and make a side-to-side anastomosis, with      slight j-loop
** Close the staple holes with      front and back sutures
* Close mesenteric and     Petersen's defects with Glubran (can also suture)