TECHNICAL ASPECTS OF THE ROUX-EN Y PATH: ANTECOLIC OR RETROCOLIC ?

1. TECHNICAL ASPECTS OF THE ROUX-EN Y PATH: ANTECOLIC OR RETROCOLIC? The Most Difficult Part

2. Antecolic vs. Retrocolic • Open Approach Literature • Laparoscopic Approach Consensus

3. Evolution Of The Process • Multiple approaches:From Below/Above • Roticulating grasper • Penrose drain- white latex free • +/- lesser sac dissection to create the “Strawberry patch”

5. Creating A Path • Prior To Formation of Roux-En Y • Identification of the Ligament of Treitz

7. Creating A Path • Prior To Formation of Roux-En Y • Identification of the Ligament of Treitz • Establishment of Mesocolic Window

9. Creating A Path • Prior To Formation of Roux-En Y • Identification of the Ligament of Treitz • Establishment of Mesocolic Window • Placement of White (Latex Free) Penrose Drain

11. Passage Of The Roux Limb • After Formation of Roux-En Y • Secure the Roux Limb • Passage of Roux Limb into Lesser Sac • Advancement of Roux Limb to Posterior Gastric Pouch

15. Final Step • Closure of Mesenteric Defect

17. Logistical 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