# reduction of stomach, closure of crura, gastropexy



## MEZIESKY (Apr 22, 2009)

Help please. I am total lost on this one. The op not read:  first he does convert to open. The hepatogastric ligament was then incised. This
was continued up to the hiatus which the stomach was identified. Starting
at the right crura the loose areolar tissue was incised. This was
continued down posteriorly and anteriorly. This allowed enough
mobilization of the stomach to allow identification of the left crura which
was the loose areolar tissue was also incised using a harmonic scalpel.
Once adequate dissection commenced, the stomach was pulled down. Other
loose areolar tissue was transected further mobilizing up the stomach.
Once this was done it was decided to perform the gastropexy.
midabdominal incisions using a scalpel through the skin into subcutaneous
tissue.  This was due to not being able to get to the angle to place the
gastrostomy tube.  Once this was accomplished and the abdomen was entered,
the stomach was visualized.  It was retracted using Babcocks.  A Foley
catheter was placed through the anterior abdominal wall into the abdominal
cavity and then clamped on itself.  The midstomach was then identified.
Vicryl #0 was used in concentric pursestrings using #0 silk.  Once this was
done a small gastrotomy was made.  The Foley catheter was placed.  The
balloon inserted.  The inner pursestring was tied and then the outer
pursestring was tied while dunking the inner one after which the lateral
stitch was placed through the anterior abdominal wall as well as the
stomach and this was tied.  The Foley catheter was then pulled.  Three more
stitches were placed in the 4 quadrants of the stomach in similar fashion.
Once this was done a gastrostomy tube stitch was placed.  The abdomen was
irrigated and dried.  Hemostasis assured after which the crura was
approximated using silk.
I've look in the stomach section for an open procedure and I'm lost
Thank you.
Marie


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