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asked in 社會與文化語言 · 1 decade ago



Under the satisfactory general anesthesia,

the patient is put in supine position,

preparing and draping as usual sterile fashion.

A midline longitudinal incision over epigastrium about 20 cm is done.

The wound is deepened into the peritoneal cavity.

Elevate the great omentum and carefully separate it from the transverse colon.

Continue the upward dissection of the great omentun,

with ligation of the upper short gastric vessels.

Remove the lesser omentum.

Ligate doubly the right and left gastric arteries .

With complete gastric mobilization from the gastroesophageal junction to the proximal portion of the second part of the duodenum,

divide the duodenum with TA 55.

Divide the abdominal esophagus.

Place stay sutures on each side of the esophagus with 1.5-0 silk and use 2-0 Prolene to perform whole layer

running suture around the esophagus.

Perform a Roux-en-Y esophagojejunal anastomosis as follows:

Divide the jejunum.

Aastomose end-to-end with the esophagus using EEA 28 .

Pass NG tube into the jejunal loop.

Anastomse the opening of the proximal jejunum and the distal jejunum to the jejunual loop in two layers.

Perform feeding jejunostomy as follows:

Insert a 14# NG tube into the jejunum,

and use two purse-string sutures to secure the catheter.

Using four 1.5 silk sutures to fix the jejunum to the anterior abdominal wall.

Irrigate the abdominal cavity with a large amount of normal saline.

Place two Jackson-Pratt drains in left subphrenic and Morrison pouch.

Close the abdomen layer by layer.

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