Mgb twisted pouch syndrome
•Download as PPTX, PDF•
1 like•279 views
Mini-Gastric Bypass Technical Errors, Tips & Pointers The Mistake of the Twisted Pouch Anterior Gastro-Jejunostomy (No it is Not A Good Idea!) Twisted Pouch Common Error in “New” Inexperienced MGB Surgeons Common in RNY surgeons Low Port sites => Twisted pouch because of poor positioning of First Staple Firing => Beginning Twist 2nd Common Error is short posterior pouch wall vs long anterior wall These two errors => Twist so that anterior pouch surface twists 180 degrees => Makes an Anterior GJ seem like a good idea; Wrong!
Recommended
More Related Content
More from Dr. Robert Rutledge
More from Dr. Robert Rutledge (20)
Recently uploaded
Recently uploaded (20)
Mgb twisted pouch syndrome
- 1. Mini-Gastric Bypass Technical Errors, Tips & Pointers The Mistake of the Twisted Pouch Anterior Gastro-Jejunostomy (No it is Not A Good Idea!)
- 2. Twisted Pouch Common Error in “New” Inexperienced MGB Surgeons Common in RNY surgeons Low Port sites => Twisted pouch because of poor positioning of First Staple Firing => Beginning Twist 2nd Common Error is short posterior pouch wall vs long anterior wall These two errors => Twist so that anterior pouch surface twists 180 degrees => Makes an Anterior GJ seem like a good idea; Wrong!
- 3. Dr Rutledge Advice: Never Do Anterior GJ Anterior GJ only “Looks Good” in the twisted MGB gastric Pouch When the anterior surface “Appears” to be a good location for the GJ ==> Means you have created a twisted Gastric Pouch Results: Post Op N&V Short and Long Term Dyspepsia Stomach Pouch => Untwists => Twisted Bowel Loop
- 4. Errors in Creating the Gastric Pouch Correct Pouch How the MGB Gastric Pouch Should Lie: Like a Normal Stomach Medial = Lesser Curvature 180 Degrees Lateral = Neo-Greater Curvature
- 5. Errors in Creating the Gastric Pouch “TWISTED” Pouch How the MGB Gastric Pouch ... Should NOT Lie: WRONG NOT Like a Normal Stomach Medial = Lesser Curvature 180 Deg Twist 9 O'clock to 3 o'clock Lateral = Neo-Greater Curvature Twist
- 6. Errors in Creating the Gastric Pouch “TWISTED” Pouch How the MGB Gastric Pouch Should NOT Lie: WRONG NOT Like a Normal Stomach Medial = Lesser Curvature 180 Deg Twist 9 O'clock to 3 o'clock Lateral = Neo-Greater Curvature Twist
- 7. Errors in Creating the Gastric Pouch “TWISTED” Pouch How the MGB Gastric Pouch Should NOT Lie: WRONG NOT Like a Normal Stomach Medial = Lesser Curvature 180 Deg Twist 9 O'clock to 3 o'clock Lateral = Neo-Greater Curvature Twist
- 8. Doing the MGB Wrong The Twisted Gastric Pouch The Neo-Gastric Pouch Should not be twisted That should be obvious The lesser curve should lie at 9 o'clock, medially The Neo-Greater curvature should lie at 3 o'clock, laterally Twisted (Wrong) pouch makes the anterior GJ “look” like a good choice
- 9. The Twisted Gastric Pouch Often Leads to Post Op Complications Twisted Gastric Pouch Syndrome: Post op Nausea and vomiting CT-Scana, Endoscopy all negative “INVISIBLE ILLNESS” Rx: Revision Prevention: Simple, Do Not Twist the Pouch & Never Anterior Anastomosis