By Henry Buchwald MD PhD
Buchwald's Atlas of Metabolic & Bariatric Surgical strategies and strategies, via best authority Henry Buchwald, MD, PhD, is the 1st pictorial atlas that demonstrates modern day complete diversity of open and laparoscopic bariatric tactics, in addition to concurrent surgical procedures resembling hernia fix and tubal ligation. countless numbers of fine quality images and illustrations assist you to in achieving the simplest results and deal with any issues that could come up. you will discover assurance of such sizzling new methods as laparoscopic electrode placement, replacement open electrode placement, laparoscopic vagal pacing, and substitute open vagal pacing. At www.expertconsult.com you could reference the full textual content and illustrations from any desktop or cellular gadget. See easy methods to practice modern complete diversity of open and laparoscopic options, in addition to concurrent surgical procedures comparable to hernia fix and tubal ligation, by means of viewing thousands of step by step images and illustrations. grasp sizzling new techniques equivalent to laparoscopic electrode placement, replacement open electrode placement, laparoscopic vagal pacing, and replacement open vagal pacing. receive the easiest effects and stay away from problems with specialist information and proposals from Dr. Henry Buchwald, who has chaired or presided over the Surgical Council of the yankee collage of foodstuff, the crucial Surgical organization, the yank Society for Bariatric surgical procedure, and different top enterprises. Reference the entire textual content and illustrations from any laptop or cellular machine at www.expertconsult.com. grasp all kinds of bariatric surgical procedures, in addition to concurrent and revisional surgical procedures with step by step visible information.
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Extra info for Buchwald's Atlas of Metabolic & Bariatric Surgical Techniques and Procedures: Expert Consult - Online and Print
Gentle pressure on both sides of the incision by the surgeon and assistant facilitate a straight line of entry. The small subcuticular bleeders are cauterized for hemostasis. ◆ Chapter 3 • Biliopancreatic Diversion 27 Figure 3-1 Figure 3-2 28 Section II • Primarily Malabsorptive Procedures Figure 3-3: The surgeon and assistant apply opposing pressure on the sides of the opening and, with considerable force, tear the subcutaneous fat and Scarpa's fascia down to the linea alba. This maneuver requires several applications of subcutaneous pulling in opposite directions along the length of the incision and usually at several depths.
The duodenum is mobilized from above and below until a clear passage beneath the duodenum is established. The vasculature of the tissue plane above the duodenum is extremely rich and requires a powered tissue divider. Care must be taken not to injure the common bile duct or other portal structures. The mesentery below the duodenum is also quite vascular and requires careful dissection and hemostasis. Once a grasper can comfortably be inserted underneath the duodenum, 4 cm from the pylorus and short of the common bile duct, the duodenum is ready for division.
S Hand-sewn anastomosis alternative. ◆ Chapter 3 • Biliopancreatic Diversion 39 Figure 3-17 Figure 3-18 40 Section II • Primarily Malabsorptive Procedures ◆ Figure 3-19: Completed biliopancreatic diversion with a nonrestrictive, large gastric pouch, a measured common channel, and a measured alimentary Roux limb. A subtotal distal gastrectomy has been performed, the duodenal stump has been carefully closed, and bowel continuity has been restored by gastrojejunostomy and jejunoileostomy, with closure of mesenteric defects.