Authors: Muhammad A Jawad
Publish Date: 2013/03/17
Volume: 23, Issue: 5, Pages: 718-718
Abstract
I am responding to the letter to the editor from Angrisani et al 1 regarding our technique of utilizing bovine pericardial patch as band in laparoscopic RouxenY gastric bypass We start with a 3–4 cm transverse cut on the lesser curvature of the stomach at the cisura angularis Then we vertically cut the stomach against 34 French bougie to create a vertically constructed pouch that resembles the shape of sleeve We checked the volume several times with the column of water placed in the bougie and it showed 15–30 ml in volume As mentioned in the manuscript 2 one transverse firing and four to six vertical firings are applied using both 45 and 60 mm linear staplersThe gastrojejunal anastomosis is done with the linear stapler as well creating the posterior stapling wall at 25 cm in length Then we close the opening against the 34 French bougie using the linear stapler which makes the opening diameter approximately 12 cm We place the pericardial patch 1–2 cm above the gastrojejunostomy without fixation Angrisani et al 1 commented that they prefer to suture the pericardial ring because they could not predict its reaction with the pouch We felt the fixation was not necessary because we were able to observe the pericardial patch adhering to and getting incorporated into the pouch without migrating vertically few months after the bypass We did not think wider patches were necessary because the whole idea was to create a fibrous band that prevents the dilation of the stoma several years after the bypass This is based on our belief that the major reason for weight regain is related to the stoma dilation and fast dumping of the food that leads to polyphagia
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