Gastrointestinal anastomosis technique – Roux-en-Y esophagojejunostomy

Anatomy Perioperative management Technique Complications Evidence Total Video

Content

Anchoring the anvil with a purse string suture
Assessing the jejunal arcades and determining the length of the afferent limb
Dissecting the Roux limb
Retrocolic transposition of the Roux limb into the upper abdomen
Esophagojejunal anastomosis
Inspecting the anastomosis and shortening the blind end
Jejunojejunostomy/ posterior wall
Jejunojejunostomy/ anterior wall
Anchoring the Roux limb and closing the mesenteric window

Authors

Prof. Dr. med. Martin Kreis

Charite Berlin

Anchoring the anvil with a purse string suture

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Open the distal esophagus by transverse transection of its anterior wall and secure it proximally with an Allis forceps; this will prevent the distal esophagus from retracting craniad into the mediastinum. Now transect the posterior wall of the esophagus. Preplace a purse string suture (monofilament, nonabsorbable, 2/0, continuous full-thickness over-and-over) and gently dilate the esophagus with a dressing forceps. Insert the anvil of a circular EEA stapler and secure it by tying the preplaced purse string suture.
Assessing the jejunal arcades and determining the length of the afferent limb

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Remark: Since this is a text-to-speech computer voice, it may mispronounce some medical terminology.

In order to achieve a good functional result, the segment of the jejunum must be dissected sufficiently long. To this end, lift the transverse colon craniad, hold up and spread the jejunal mesentery and under transillumination with the surgical light assess the arterial supply of the second jejunal loop. The intestine and mesentery of the efferent limb should be transected such that the transected end of the limb will easily reach the esophagus.