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Port placement depends on the planned procedure. Since laparoscopic biliary bypass is often performed in conjunction with endoscopic staging and doudenal bypass several port configurations exist, dependent on the planned procedure. |
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The initial inspection of the abdomen includes the selection of a section of small bowel for the bypass procedures. A section of jejunum at least 30 to 40 cm from the ligament of Treitz is chosen. If a gastrojejunostomy is also planned then an additional 10 cm of small bowel is mobilized. |
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A stabilization suture is placed through the right upper abdominal wall and then passed from the jejunum to the gallbladder fundus and back out the abdominal wall at the point where it entered. A 3-0 nylon on a Keith needle is employed. |
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The enterotomies for the stapling device are made. Two handed technique and cautery are used to limit tangential dissection, and ensure hemostasis. |
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A GIA 30 or equivalent device is used and a single application produces ample anastomotic area. |
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The enterotomy sites are either hand sewn or closed with a second staple line. Attention is directed towards preserving the cross sectional diameter of efferent jejunal limb. Control of the anastomosis during the procedure is preserved by the utilization of the stabilizing suture throughout the case. |
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