Operation on stomach and pylorus

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One of subtotal gastrectomy (gastroduodenal anastomosis)
time:2021-10-27   click :1173

1、 Subtotal gastrectomy with end-to-end anastomosis of residual stomach and duodenum
1. Firstly, most of the distal stomach was removed with Huaxia disposable linear suture device, and the broken end of duodenum was sutured with purse strings (Fig. 2-4-1).

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Figure 2-4-1 place a purse string suture device on the duodenal bulb and remove most of the stomach with a Huaxia disposable linear suture device

2. Make a small incision in the anterior wall of the stomach, insert the Huaxia disposable tubular stapler into the stomach, insert the nail butting seat of the Huaxia disposable tubular stapler into the duodenal bulb, tighten the ligation purse string, poke a small opening at the broken end of the great bend side of the stomach, insert the central rod into the stapler body, connect the nail butting seat with the body, and then prepare for striking anastomosis (Fig. 2-4-2).
3. After gastroduodenal end-to-end anastomosis, exit the Huaxia disposable tubular stapler, and close the anterior gastric wall incision with a disposable linear stapler (Fig. 2-4-3).
4. When cutting off the gastric body, use the Huaxia disposable linear suture to close the small curved side of the proximal end, leaving the large curved side to be anastomosed. The duodenal bulb is also open, and use the traction line to make the two broken ends close (Fig. 2-4-4).

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Fig. 2-4-2 butt joint of Huaxia disposable tubular stapler and butting base extending from the anterior wall of stomach

 

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Figure 2-4-3 close the small opening on the anterior wall of the stomach to complete gastroduodenal anastomosis

5. Suture the posterior wall with Huaxia disposable linear suture device. Note that the gastroduodenal tissue of the posterior wall must be lifted with traction thread, and the suture nails shall be nailed on the whole layer and full length of the tissue (Fig. 2-4-5).

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Fig. 2-4-4 the cut end of the small bend side of the stomach is closed, and the posterior wall of the broken end of the gastroduodenum is lifted by the three line method

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Fig. 2-4-5 suture the posterior wall of anastomosis with Huaxia disposable linear stapler

6. Suture the anterior wall in the same way to complete gastroduodenal end-to-end anastomosis (Fig. 2-4-6).

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Figure 2-4-6 suture the anterior wall of the anastomosis to complete the operation

2、 Subtotal gastrectomy, end to side anastomosis of duodenum and gastric stump
1. After subtotal resection of the distal stomach, close the proximal stomach with Huaxia disposable linear stapler, cut a small opening from the anterior wall of the remnant stomach, insert the Huaxia disposable tubular stapler body, extend the central rod from the posterior wall, and tie it tightly with purse string. Note that the front and rear wall poke incision shall be at least 2.5cm away from a suture (Fig. 2-4-7).

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Fig. 2-4-7 incision in the anterior wall of stomach with the central rod protruding from the posterior wall

2. Insert the nail butting seat into the duodenal bulb, tie the purse string, and connect the nail butting seat with the body (Fig. 2-4-8).

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Figure 2-4-8 two parts of Huaxia stapler have been connected

 

3. Fire the Huaxia disposable tubular stapler, rotate and open the instrument, and slowly exit the Huaxia disposable tubular stapler by swinging the tail of a fish (Fig. 2-4-9).

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Figure 2-4-9 pull out after firing Huaxia stapler

 

4. After determining whether the anastomosis is successful, close the anterior gastric wall incision with Huaxia disposable linear suture device (Fig. 2-4-10).

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Fig. 2-4-10 side to side gastroduodenal anastomosis by closing the anterior gastric wall incision

5. If the stomach disease becomes benign damage, gastroduodenal anastomosis can be treated in the following ways. Firstly, the duodenal bulb was cut off and the duodenal stump was sutured with purse strings (Fig. 2-4-11).

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Figure 2-4-11 Chinese disposable tubular stapler extending into gastric cavity

 

6. The stomach will not be removed for the time being, extend the Huaxia disposable tubular stapler into the gastric cavity, and extend the central rod 3cm from the posterior wall of the stomach to the proximal side of the predetermined gastric cutting line (Fig. 2-4-12).

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Fig. 2-4-12 central rod protruding from the posterior wall of stomach

7. Connect the nail holder in the duodenum with the body and close it (Fig. 2-4-13).

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Figure 2-4-13 two parts of stapler connected

8. Fire the stapler, open the stapler and exit slowly (Fig. 2-4-14).

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Figure 2-4-14 complete gastroduodenal anastomosis and extract the stapler

9. Close the proximal stomach with Huaxia disposable linear stapler and remove the distal stomach (Fig. 2-4-15). End to side anastomosis of duodenum and stomach has been completed (Fig. 2-4-16).

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Fig. 2-4-15 suture to close the gastric cavity and remove excess gastric tissue

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Figure 2-4-16 status after completion of all operations


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