Bariatrics

Question 1

Elrainy TRA

Answer 1

Due to tissue thickness variation linear cutting Staplers with thicker reloads are recommended at the antrum

Question 2

Elrainy results EJ

Answer 2

Thinnest at proximal Esophageal junction
Thickest near pylorus
Thinner along greater curvature
Gender and location have an effect on tissue thickness

Question 3

Rawlins 2013 study metrics

Answer 3

Significant differences at each location
Antrum thickest 2.7mm
Mid body 2.33mm
Fundus 1.97mm
BMI >50kg/M2 and gender were associated with thicker reloads but only at the antrum

Question 4

Rawlins 2013 suggests

Answer 4

Thicker reloads such as black when when above factors are present.
Significant changes in tissue thickness at 4/5th fire suggest stepwise alteration here.

Question 5

Roux-En-Y Gastric Bypass - restrictive & malabsorbative low pressure less incidence reflux
Operation steps

Answer 5

1. Trocars ( smiley face)
2. Mobilise - upper portion of stomach + adhesiolysis
3. Create the pouch
4. Transect the jejunum
5. Create otomies in prep for jejunojunostomy in distal end of BPD limb bypassed stomach / duodenum limb & Roux/ food alimentary limb.
6. Perform the anastomosis jejunostomy & close otomies
7. Create the otomies in stomach pouch & jejunum - perform gastrojejunostomy
8. Leak test & close

Question 6

Sleeve Gastrectomy - restrictive high pressure
Stomach reduced to 15% of original size
Sphincters remain intact

Answer 6

1. Trocars
2. Reduction of hiatal hernia if present
3. Mobilise greater curvature & posterior attachments of stomach,ligate gastric vessels, take down adhesions
4. Create the sleeve with or without buttressing
5. Oversew or reinforce staple line if required
6. Leak test
7. Remove stomach reminant
8. Close

Question 7

The single anastomosis duodenum-Ileal bypass with sleeve gastrectomy SADI-S involves 2 steps what are they?

Answer 7

1. Sleeve gastrectomy
2. Duodenum divided just below the stomach pylorus retained and reattached ( anastomosed) to a loop of intestine 2 metres further downstream.