• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We're introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

Takedown gastric fistula, Roux-en-Y fistula jejunostomy, & dx lap

nlbarnes

Guru
Messages
182
Location
Oceanside, CA
Best answers
0
Preoperative Dx: Gastric fistula S/P sleeve gastrectomy

Procedure: Takedown of gastric fistula, Roux-en-Y fistula jejunostomy, & dx lap

Fistula was below the angle of his. The was a tremendous amount of scarring & due to that & inflammatory tissue in this are, & dissection could not be done safely laparoscopically. Trocars were removed & procedure was performed open. Inferior edge of the sleeve along greater curvature side was dissected free. Stomach was freed. Fistula was id'd. Roux-en-Y fistula jejunostomy was determined to be the best course. Jejunum was anastomosed to the biliary limb in a sid-to-side fashion using the Endo stapler. Enterotomies were closed - inner & outer layer. Mesenteric defect was closed. Roux limb was brought through transverse mesocolon in a retrocolic fashion in antigastric. a side-to-side anastomosis was performed in 2 layers. A nasogastric tube was passed into the Roux limb. Roux limb was tacked to the transverse mesocolon closing this defect using interrupted sutures. Drains were passed through the trocar site, one placed in the subhepatic region, the other placed along the site of the anastomosis in the LT subdiaphragmatic region.
 
Top