Department of Bariatric Surgery, CHU Hospital, Jean Monnet University, Saint Etienne, France.
Department of Bariatric Surgery, Clinique Chirurgicale Mutualiste de Saint Etienne, France.
Int J Surg. 2014 Nov;12(11):1151-6. doi: 10.1016/j.ijsu.2014.08.409. Epub 2014 Sep 16.
In bariatric surgery, it is essential to completely release the Fundus in order to create a narrow gastric pouch. The upper part of the fundus is located above the omental bursa and is therefore retro-peritoneal. In order to release this completely, not only does the arterial supply to the fundus need to be divided to visualise the left diaphragmatic pillar, but the right attachment beginning at the left diaphragmatic pillar and running towards the fundus needs to be divided. This minimal dissection is compensated by further dissection at the level of the left diaphragmatic pillar and traction on the stomach from right to left during the final division stapling division process. The surgeon still has the impression of having released the posterior aspect of the Fundus, exposing the pillar of the diaphragm, although in fact part of the Fundus still remains adherent to the diaphragm and is therefore not released.
在减重手术中，为了创建一个狭窄的胃囊，彻底释放胃底是至关重要的。胃底的上部位于网膜囊上方，因此是腹膜后位。为了完全释放胃底，不仅需要切断胃底的动脉供应以显露出左侧膈肌支柱，还需要切断从左侧膈肌支柱开始并向胃底延伸的右侧附着处。这种最小的解剖补偿了在左侧膈肌支柱水平进一步的解剖和在最终切割吻合过程中从右侧向左牵拉胃的操作。尽管实际上部分胃底仍然附着在膈肌上而未被释放，但外科医生仍然会有一种已经释放了胃底后侧面、暴露了膈肌支柱的印象。
