PubMed · 14935974
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J GREGORY. 1952. Gastroenterostomy.. https://pubmed.ncbi.nlm.nih.gov/14935974/
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Ultrasonography is the first line imaging investigation in patients with jaundice, right upper quadrant pain, or hepatomegaly. Most patients with jaundice have parenchymal or obstructive jaundice. A 56-year old man was admitted to the Institute of Digestive Diseases, Belgrade, with severe pains in the epigastrium, vomiting, icteric coloration of sclera, white stools and dark urine. The symptoms had developed 5 days after a Billroth II resection. The functional liver test indicated a pronounced cholestasis. Real-time ultrasonography showed in the projection of the pancreas head, a clear bordered unechogenic oval formation, with a size of 40 x 35 mm. This finding indicated a possibility of an afferent loop obstruction, accompanied by consecutive obstructive icterus due to compression on the common bile duct. Ultrasonographic examination was followed by surgical reintervention. With the development of noninvasive imaging, transcutaneous ultrasonography, computed tomography and magnetic resonance imaging, the diagnosis of pancreatic and other cysts in upper abdomen is usually straightforward. The important ultrasonographic characteristic of empty organs, compared to cysts and pseudocyts, is a change in the morphology and size of organs after a specific time interval. Air bubbles in the organs lumen are like mobile reflectors, and they are an important sign in identifying segments of the gastrointestinal tract.
BACKGROUND: We developed the laparoscopic gastric bypass in 1993 and first reported the technique and results in 1994. The technique for the gastroenterostomy was derived from the method used in the percutaneous endoscopic gastrostomy tube placement. Some have questioned the safety of this technique, and alternatives have been proposed. METHOD: Prospectively, we have followed and recorded the results of our laparoscopic patients. To date we have performed over 1,400 laparoscopic gastric bypass operations using the same technique of anvil placement: pulling the anvil down from the mouth to the stomach pouch with a percutaneously placed wire. All patients underwent upper GI endoscopy following the anvil placement, and a water-soluble upper GI series was obtained on the first postoperative day. RESULTS: There have been no esophageal injuries in the first 1400 patients on whom this technique was done. CONCLUSION: The percutaneous pull-wire technique is a safe and effective method to place the 21-mm circular stapler anvil for the performance of a laparoscopic gastroenterostomy.