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1. Introduction
2. Abdominal Exploration
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a. Dissect Fat
b. Open Peritoneum
c. Examine Abdominal Cavity for Metastases
d. Examine Surface of Liver
3. Mobilization of Greater Omentum
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a. Omentum Dissection
b. Enter Lesser Sac
c. Division of Falciform Ligament
4. Infrapyloric Mobilization
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a. Divide Right Gastroepiploic Vein
b. Divide Right Gastroepiploic Artery
c. Station 6 Lymph Node Dissection
d. Identification of Cancer
e. Continued Dissection
5. Superpyloric Dissection
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a. Open Lesser Omentum
b. Divide Right Gastric Vessels
c. Dissect Station 5 Lymph Nodes
6. Duodenal Transection
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a. Duodenal Stump
b. Leftward Dissection
7. Greater Curvature Mobilization
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a. Open Peritoneum
b. Ligate Left Gastric Vein
c. Dissect Nodal Package on Surface of Pancreas
d. Open Peritoneum on Superior Border
e. Division of Left Gastric Artery
8. Gastrectomy
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a. Pull NG Tube Back
b. Dissection of Station 3 Lymph Nodes
c. Gastric Division
d. Establish Hemostasis
9. Billroth II Reconstruction
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a. Oversew Lesser Curve Staple Line
b. Jejunum Loop
c. Corner Stitches
d. Back Row of Lembert Sutures
e. Enterotomies
f. Full Thickness Anastomosis
g. Connell Suture
h. Top Layer of Lembert Sutures
i. Advance NG Tube
10. Closure
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a. Removal of Additional Lymph Nosed
b. Close Mesenteric Trap
c. Close Fascia
d. Skin Closure
e. RF Wand
11. Debrief
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Distal Gastrectomy (Open)
John T. Mullen, MD
,
Andrea L. Merrill, MD
Massachusetts General Hospital
Tags:
General Surgery
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Authors
John Mullen
Andrea L. Merrill, MD
Filmed At:
Massachusetts General Hospital
Article Information
Publication Date
N/A
Article ID
191
Production ID
0191
Volume
N/A
Issue
191
DOI
https://doi.org/10.24296/jomi/191