Laparoscopic Minimal Gastric Bypass

Education event Sponsored by: Meril Life

Conference Name: Bariatric Series - Meril

Conducted by: Meril Endosurgery In association with Care Hospitals, Banjara Hills

Surgeon(s)/Speaker(s): Dr. Krishnamohan Yarlagadda

Surgical Procedure: Bariatric-Mini Gastric Bypass

Location: Care Hospital, Hyderabad

1. Create pneumoperitoneum :

2. Place ports appropriately :

3. Place 36 fr boogie in stomach :

4. Start from 4cm proximal to pylorus on lesser curvature :

5. Create window in lesser sac :

6. Fire first stapler cartridge from lesser curvature :

7. Second cartridge fired : Second cartridge fired after adjusting the direction of stapler to form gastric sleeve

8. Fire cartridges : fire cartridges and end 1cm away from GE junction and thus form gastric sleeve

9. Identify Ligament of treitz : Identify Ligament of treitz and measure the small intestine for 150cm / 180 cm approx by graspers

10. complete GJ anastomosis :

11. place the drain and come out :

1. Port Position MGB : Port Position MGB.

1. SCD (Sequential compression Device) : For DVT prophylaxis

2. SCD (Sequential compression Device) : Secure strapping of patient

1. Preoperative investigations : HOMOCYSTEINE :new:Haemogram :new:ELECTROLYTE PROFILE :new:HOMA IR :new:Liver Function Profile :new:Activated Partial :new:Thromboplastin Time (APTT) :new:INSULIN -FASTING SERUM :new:PHOSPHORUS SERUM :new:Calcium Total :new:TESTOSTERONE TOTAL :new:Thyroid Profile-1

2. Preoperative measures : Liquid diet for about 2 weeks @ 800 kcal per day :new:Pre operative optimization of co morbidities (eg: glycemic control , hypertension, hypothyroid etc) :new:Pre operative spirometry

3. Preoperative measures : Intravenous venous fluids. :new:DUF prophylaxis (SCD, Stockings) :new:Start thromboprophylaxis with after 6 hours :new:Early ambulation :new:Incentive Spirometry

4. Warning signs in the postoperative period : :new:Tachycardia :new:Hypotension :new:Drain output (constituency, amount) :new:Fever :new:Shortness of breath

1. Veress needle

2. 12 mm Trocar

3. 5 mm Trocar

4. 45 degree telescope

5. Harmonic Scalpel

6. Stapler

7. Suture

8. 9.8 mm Gastroscope

9. Grasper

10. Maryland Dissector

11. Energy source

12. Staple-line reinforcers

13. Orogastric tube

14. Bariatric Endostapler

15. Laproscopic 45 cm length instruments

16. Bougie 36 fr size

17. Liver Retractor

18. Visiports 12mm 3 nos