Ileal inter position sleeve

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Surgeon(s)/Speaker(s): Dr. Surena Ugale

Surgical Procedure: Bariatric-Ileal Interposition

Location: Kirloskar Hospital Hyderabad

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Indexsteps

1. Overview : Overview of Ileal interposition

2. Variable Sleeve Gastrectomy : Variable Sleeve Gastrectomy

3. 1st part Duodenal Mobilization : 1st part Duodenal Mobilization

4. 1st Transection : 1st Transection-Duodenal 2cm from Pylorus

5. Retro-colic Trasns-mesentric window : Retro-colic Trans-mesenteric window

6. Distal stomach brought down through window : Distal stomach brought down through window

7. Stitch Marked Jejunum at 50cm from DJ junction : Stitch Marked Jejunum at 50cm from DJ junction

8. 2nd Transection : 2nd Transection-Ileal 30cm from IC junction

9. Measure 170cm ileum-Ileal segment for interposition : Measure 170cm ileum-Ileal segment for interposition

10. 3rd Transection : 3rd Transection-ileum at 170cm mark

11. 1st Anastomosis : 1st Anastomosis-Ileal-ileal-restores continuity

12. Enterotomy close : Enterotomy close-Single layer –hand sewn

13. Mesenteric opening close : Mesenteric opening close

14. 2nd Anastomosis : 2nd Anastomosis-Duodenal- ileal (proximal end of ileal segment) 3 layer hand sewn

15. Mesenteric opening close : Mesenteric opening close

16. 3rd anastomosis : 3rd anastomosis-Jejunal(at 50cm mark)-Ileal(Distal end of ileal segment)

17. Enterotomy close : Enterotomy close-Single layer –hand sewn

18. Mesenteric opening close : Mesenteric opening close

19. Operation complete : Duodenal-Ileal Interposition with variable sleeve gastrectomy completed

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port positions

1. Port position- Duodenal-Ileal Interposition with variable sleeve gastrectomy : 6 ports- one 10mm, two-12mm, three 5mm

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Surgical Instruments

1. Stapler

2. Ultrasonic dissector

3. Harmonic Scalpel