By William H. ReMine M.D.,M.S. (Surg.) D.Sc.(Hon), W. Spencer Payne M.D.,M.S., Jon A. van Heerden M.B., Ch.B. (Cape Town) F.R.C.S. (C) (auth.)
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Additional info for Manual of Upper Gastrointestinal Surgery
The care of patients who undergo vagotomy, antrectomy, and a Roux-Y gastric drainage procedure differs little from that of patients who undergo any other transabdominal gastric operation. The one exception is our compUlsion to perform a Gastrografin contrast study on all patients who have undergone an esophageal operation prior to instituting an oral diet. If leakage is encountered, a subclavian venous parenteral alimentation line is inserted, and oral intake is withheld until sufficient healing occurs.
A Richardson retractor is inserted through the hiatus, and traction is applied ventrally. The left hand of the surgeon is inserted through the patulous hiatus with the index finger on the thoracic side and the other three fingers on the abdominal side of the phren oesophageal ligament medial to the esophagus. With the phrenoesophageal ligament and underlying peritoneum under traction, they are divided with scissors. The upper gastrohepatic omentum is clamped, divided, and ligated through the esophageal hiatus.
This technique effectively alters the corrosive quality of the gastric contents. Such a gastric drainage procedure with antrectomy-vagotomy is also applicable for the rare circumstance in which transmural esophagitis has totally and permanently fixed the shortened esophagus in the mediastinum so that mobilization and antireflux measures are technically impossible to achieve. For long, undilatable esophageal strictures or for those located in the middle and upper thirds of the thoracic esophagus, a modified Ivor-Lewis-type resection and reconstruction is recommended.
Manual of Upper Gastrointestinal Surgery by William H. ReMine M.D.,M.S. (Surg.) D.Sc.(Hon), W. Spencer Payne M.D.,M.S., Jon A. van Heerden M.B., Ch.B. (Cape Town) F.R.C.S. (C) (auth.)