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Extra resources for Manual of Upper Gastrointestinal Surgery
Feeding at this point is disastrous. Thus, when a confined leak is detected, suction decompression of the stomach with a nasogastric tube and parenteral alimentation, with delivery of 2,000 to 3,000 calories per day, are continued. An additional 2 weeks is then allowed to elapse before restudy. If evidence of leak is still present, parenteral alimentation is continued for a total of 3 weeks before an oral diet is resumed. If nasogastric drainage stops or becomes minimal during this time, the nasogastric tube can be safely removed.
1-46). With about 10 cm of the greater curvature of the stomach so mobilized into the chest, the esophagogastric fat pad is then excised. Again, care is taken to identify and preserve both vagal trunks. The passage of a 50-F Maloney dilator from the mouth down the esophagus into the stomach aids in this dissection. 45 The Esophagus and Esophagogastric Junction Figure 1-47 The greater curvature of the stomach is then grasped with lung clamps. With both the anterior and posterior aspects of the proximal stomach in clear view in the thorax, a TA 30 stapling device (without aligning pin) is applied to the stomach at the angle of His, parallel to the lesser curvature and the indwelling Maloney dilator (Fig.
The rows of staples are then buried beneath a row of interrupted 3-0 silk sutures. A mattress suture at the very apex of the cut is placed to prevent tearing and bleeding at this unstapled, vulnerable angle. In patients with a shortened esophagus, the fundus of the stomach is often attenuated, and after the cut Collis gastroplasty is performed, often little more than a finger-like pedicle of fundus encircles the neoesophagus. Vagotomy-Antrectomy Roux-Y. The individual steps of truncal vagotomy-gastric antrectomy and an 18-inch-Iong Roux-Y gastric drainage procedure are identical to those shown in a subsequent chapter (see Fig.