TECHNICAL ASPECTS OF TECHNICAL ASPECTS OF THE ROUX-EN Y PATH: THE ROUX-EN Y PATH:

ANTECOLIC OR ANTECOLIC OR RETROCOLICRETROCOLIC ?? The Most Difficult PartThe Most Difficult Part

Antecolic vs. RetrocolicAntecolic vs. Retrocolic

Open Approach LiteratureOpen Approach Literature Laparoscopic Approach ConsensusLaparoscopic Approach Consensus

Evolution Of The ProcessEvolution Of The Process

Multiple approaches: From Below/Above

Roticulating grasper Penrose drain- white latex free +/- lesser sac dissection to create

the “Strawberry patch”

Creating A PathCreating A Path

Prior To Formation of Roux-En YPrior To Formation of Roux-En Y Identification of the Ligament of TreitzIdentification of the Ligament of Treitz

Creating A PathCreating A Path

Prior To Formation of Roux-En YPrior To Formation of Roux-En Y Identification of the Ligament of TreitzIdentification of the Ligament of Treitz Establishment of Mesocolic WindowEstablishment of Mesocolic Window

Creating A PathCreating A Path

Prior To Formation of Roux-En YPrior To Formation of Roux-En Y Identification of the Ligament of TreitzIdentification of the Ligament of Treitz Establishment of Mesocolic Window Establishment of Mesocolic Window Placement of White (Latex Free) Penrose DrainPlacement of White (Latex Free) Penrose Drain

Passage Of The Roux LimbPassage Of The Roux Limb

After Formation of Roux-En YAfter Formation of Roux-En Y Secure the Roux LimbSecure the Roux Limb Passage of Roux Limb into Lesser SacPassage of Roux Limb into Lesser Sac Advancement of Roux Limb to Posterior Gastric Advancement of Roux Limb to Posterior Gastric

PouchPouch

Final StepFinal Step

Closure of Mesenteric DefectClosure of Mesenteric Defect

Logistical TipsLogistical Tips

Use all “4 hands” Only 1 hand moves at a time “Triangulate” the mesenteric opening See the posterior stomach See and Grasp the penrose drain