# Revision of gastrojejunostomy w/ excision of previous anastomosis



## nlbarnes (Nov 20, 2017)

43860 &?

Procedure:  Revision of gastrojejunostomy with excision of previous anastomosis.

Trocar placed.  Junction of the stomach & the jejunum was inspected & adhesions between this area & the gastric remnant were taken down.  Posterior to the digastric pouch at the level of the gastrojejunostomy separating this are completely from the gastric remnant.  Small bowel was free in the are of the Roux limb leading up to the anastomosis & divided.  Stomach was divided above the GJ anastomosis in an area with good blood supply & clearly separate from the ulcerated are.  2 applications of a green cartridge were used for this division.  The tissue posterior to the ulcerated area was inspected & it appeared that the posterior surface of the stomach was beginning to perforate in this are posteriorly.  The mesentery of the short piece of small intestine to be resected was divided.  Roux limb easily reached gastric pouch.  Anastomosis was performed approximating the Roux limb to the gastric pouch in a 2 layer fashion.  Vicryl was placed as a posterior sermuscular running stitch & the stomach & small bowel were then opened on either side passing thru the gastrotomy.  Closure of the anastomosis was performed.  Anterior row of seromuscular sutures was used to complete the anastomosis.

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