Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1002_Библиотеки_им_академика_М_И_Перельмана

We followed these surgical steps: we started with the identication of the duode­noileostomy anastomosis. We next deconstructed the duodenoileostomy and iso­lated the alimentary limb (Fig.52.2). We then dissected 2cm of the duodenal stump (isolated from the previous surgery; Fig.52.2a–c), and we performed a hand- sewn end-to-end duodenoduodenostomy (Fig.52.2d). This is the most challenging step in the surgery. A leak test was performed through endoscopy. We next removed the 20 proximal centimeters of the alimentary limb (Fig.52.3a, b). In the next step, we fol­lowed the alimentary limb to the jejunojejunostomy, and we divided the biliopan­creatic limb near the jejunojejunostomy (Fig.52.3c). We then performed the new side-to-side jejunojejunostomy proximally to alimentary limb and distally to bilio­pancreatic limb (Fig.52.3d, e). Finally, we closed the mesenteric defect. Our patient had no intra- or postoperative complications, and the patient was discharged after 4days. One year later, the patient had a BMI of 24kg/m2 and did not present epi­sodes of symptomatic hypoglycemia.