Iliomesenteric venous bypass for occlusion of the superior mesenteric artery

Perform median laparotomy from the xiphoid down to the symphysis, carrying the incision to the left of the umbilicus.

Open the retroperitoneum to the right lateral of the palpable aorta, coagulating any small visible vessels prior to transection. Locate the inferior mesenteric vein.

Tip:

An incision midway over the aorta may cause more severe bleeding from small, anteroaortic vessels, and there is the risk of inadvertent injury to the inferior mesenteric artery. An incision carried more to the right avoids these risks.

Along the course of the mesenteric axis, the superior mesenteric artery is located using a Doppler ultrasound probe.

Tip:

Sometimes it is difficult to palpate the stenosed or occluded vessel, especially if the mesentery is very fatty. In such cases, as demonstrated in the video clip, it is helpful to locate the position of the artery with a Doppler ultrasound probe prior to incision of the mesentery.

The small intestine is displaced to the right and enclosed in a plastic sheet. The transverse colon and the greater omentum are displaced into the upper abdomen and held upwards with a moist abdominal towel and a blade of the retractor system. After placing a moist abdominal towel, the mesentery of the descending colon is displaced to the left with another blade.

Tip:

Wrapping the small intestine in a plastic bag ensures that the bowel remains moist and does not sustain serosal lesions. This can also help prevent postoperative adhesions.