Emergency Roux-en-Y jejunostomy for caustic lesion of the esophagus

This video shows a Roux-en-Y alimentary jejunostomy in a 48-year-old patient who had had symptoms of maniac and depressive psychosis and who had tried to commit suicide by drinking a cleaning product. This caused an ischemia without necrosis all along the esophagus, without reaching the stomach.

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Emergency Roux-en-Y jejunostomy for caustic lesion of the esophagus

Authors

F Costantino, J Marescaux

Abstract

This video shows a Roux-en-Y alimentary jejunostomy in a 48-year-old patient who had had symptoms of maniac and depressive psychosis and who had tried to commit suicide by drinking a cleaning product. This caused an ischemia without necrosis all along the esophagus, without reaching the stomach.

Classification

tips and tricks

Keywords

Roux-en-Y, alimentary jejunostomy

Media type

Surgical video

Duration

03'17''

Publication

2010-09

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E-publication

WeBSurg.com, Sept 2010;10(09).
URL: http://www.websurg.com/doi-vd01en2836.htm

Emergency Roux-en-Y jejunostomy for caustic lesion of the esophagus

1. Introduction 00'15''

This video shows a Roux-en-Y alimentary jejunostomy in a 48-year-old patient who had had symptoms of maniac and depressive psychosis and who had tried to commit suicide by drinking a cleaning product. This caused an ischemia without necrosis all along the esophagus, without reaching the stomach.

2. Port insertion 00'33''

An alimentary jejunostomy is decided upon in order to perform medical treatment, since surgical treatment had been ruled out by the emergency department. A 10mm umbilical port and two 5 mm ports, placed respectively in the right and left flank, are introduced. The two 5 mm ports will be associated to another 5 mm epigastric port. The maneuver is performed at the level of the second jejunal loop.

3. Transmesenteric jejunal loop passage 01'03''

A transmesenteric passage is carried out at this time in the procedure and the jejunal loop is divided using an Endo-GIA linear stapler. Next, a thread is placed to mantain the two loops.

4. Side-to-side jejunojejunal anastomosis 01'18''

An enterotomy is performed using monopolar cautery. It will allow for the introduction of a 60mm Endo-GIA linear stapler in order to perform a mechanical isoperistaltic side-to-side anastomosis. Once the stapler has been introduced, the angles of the anastomosis are reached.

5. Intestinal defect closure 01'57''

The closure of the intestinal defect begins with the introduction of a PDS 3/0 thread. The maneuver is started at the inferior angle of the anastomosis in order to gain a correct exposure, which will allow for a perfect suture of the anastomosis. The superior portion of the anastomotic defect is closed by placing a second PDS 3/0 thread, approximately 20cm long. A continuous suture is placed in order to close the intestinal defect.

6. Mesenteric defect closure 02'43''

The mesenteric defect is then closed as well. To do so, a non-absorbable monofilament is used in order to prevent internal hernias from occurring.

7. Alimentary loop 03'20''

Finally, the alimentary loop is opened and fixed at the level of the skin.