Open Antrectomy, Duodenal Resection, and Gastrojejunostomy for a Multiple Endocrine Neoplasia Tumor

Anesthesia/Prep/Drape

After adequate general endotracheal anesthesia was obtained, the patient was sterilely prepped and draped in standard fashion.

Exposure

1. Midline abdominal incision, enter peritoneum
2. Entry of Lesser Sac using Wide Kocher Maneuver
3. Evaluation of Pylorus and Duodenum

Duodenal Resection

4. Ligation of right gastroepiploic artery and right gastric artery
5. Examine Pylorus and Duodenum for tumor
6. Division of Duodenum

Gastric Resection

7. Mobilization of stomach and division of short vessels along the lesser and greater curvature
8. Resection of Antrum and send specimen for pathology

Retrocolic Gastrojejunostomy

9. Mobilization of Jejunum to stomach in retrocolic fashion
10. Two layer anastomosis
    1. Interrupted 3-0 silk (outer layer)
    2. Running 3-0 Vicryl (inner layer)
11. Lembert Sutures
12. Bring anastomosis through trap and suture in place

Closure

13. Abdominal Fascia closed with #1 Running Prolene
14. Skin closed with staples