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Title
1. Introduction
2. Abdominal Exploration
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a. Incision and Dissection to Fascia
b. Open Peritoneum
c. Examine Abdominal Cavity for Metastases
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 Nodes
b. Close Mesenteric Trap
c. Close Fascia
d. Skin Closure
e. RF Wand
11. Post-op Remarks
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Open Distal Gastrectomy
Andrea L. Merrill, MD
;
John T. Mullen, MD
Massachusetts General Hospital
Tags:
General Surgery
Oncologic Surgery
Multidisciplinary Surgery
Main Text
Procedure Outline
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Authors
Andrea L. Merrill, MD
John T. Mullen, MD
Filmed At:
Massachusetts General Hospital
Article Information
Publication Date
6/27/2024
Article ID
191
Production ID
0191
Volume
2024
Issue
191
DOI
https://doi.org/10.24296/jomi/191