STOMACH > Laparoscopic Total Gastrectomy for Corrosive Injury Stomach

Patient and Port position: Patient placed in modified Lloyd Davies position.

Pneumoperitoneum created by veress needle through 10 mm Supraumbilical skin incision which was later on converted into 10mm camera port. 12mm right and left MCL ports, 5mm epigastric port, 5mm left anterior axillary line ports were made.

STEPS :
Initial step is to visualize all quadrants of peritoneal cavity, liver surfaces, pelvis for lymphadenopathy and ascites.

Gastro colic ligament divided close to stomach wall from mid part of greater curvature to right gastroepiplocic vessels. Right gastroepiplocic vessels ligated & divided. Hepatoduodenal ligament dissected. Right gastric vessels ligated and divided. D1 dissected from pancreas & divided by endo GIA blue stapler 2cm distal to pylorus. Lower end of esophagus divided at GE junction by endo GIA blue stapler. Duodenal margin reinforced by 3-0 silk sutures.  Roux limb prepared by dividing jejunum 20 cm away from DJ flexure. Distal part of jejunum taken up in retrocolic manner and gastrojejunostomy done by CDH stapler. Side to side jejunojejunostomy done by linear stapler 60 cm distal to GJ anastomosis. Specimen taken out through small upper midline skin incision.