腹腔镜胃袖状切除术的解剖环境质量

Anatomical Quality Criteria for Sleeve Gastrectomy

Fabio Frosio1 Co Amal Suhool1 Co Jean-Marc Ferraz1 Co Brice Gayet1,2 Co Marie-Christine Boutron1,3 Co

Guillaume Pourcher1,3

Obesity Surgery

A prospective photographic study that captured every phase of each procedure was completed. The photographic documentation was carefully examined in order to identify anatomical criteria that would help make our technique reproducible.

One hundred thirty-four consecutive laparoscopic SG were photographed, and four reproducible anatomical criteria were identified:

(1) to preserve the gastric antral posterior ligament (GAPL);

(2) to dissect the gastro-pancreatic ligament (GPL);

(3) to expose the right edge of the left diaphragmatic crus;

(4) to ensure staple-line linearity.

Fig. 1 First step: getting the access at the retro-epiploic cavity

Fig. 2 The gastric antral posterior ligament (GAPL, arrow) is well identifiable after dissection of the gastro-epiploic ligament (dashed line)

Fig. 3 Superior border of the pancreas (dashed line) and gastropancreatic ligament (GPL, arrows)

Fig. 4 Posterior gastric artery (PGA, arrow) and gastro-phrenic ligament (dashed arrow)

Fig. 5 Stapling starts right from the GAPL (dashed line)

Fig. 6 Perfect linearity of the staple line, with no overlaps and no twists

归纳四个解剖标志：

1. 小肠窦部与肾上腺彼此之间的GAPL（小肠窦部肾上腺半月板），标志着远端人体内到位

2. 人体内小肠后面与肾上腺粘连，离断小肠后动脉，显露小肠后面小弯侧的腹腔

3. 小肠底部小肠脾与小肠膈半月板离断。显露左侧膈肌角右缘

4. 西侧小肠前后壁小弯侧腹腔时域切割，防止小肠扭转或折叠。