How does area not become necrotic?

Because there is still blood suppy?

I'm sure some scar tissue does develop, but just becasue the area is sectioned off so it can't receive food, doesn't mean that part of the gut isn't getting nourishment/waste removal from the blood supply.

In the standard Roux the stomach is sectioned off and left intact including the blood supply as seen here:
http://www.laparoscopy.com/obesity/roux.html

In the lap band there is no resection and the blood supply is unaffected as can be seen here:
http://www.obesitylapbandsurgery.com/tecmain.html

There are older surgeries such as gastric stapling which involved running rows of staples and partitioning the stomach. There were a number of problems with these and they have largely been abandoned. The lower picture on this page shows the older style:
http://images.google.com/imgres?imgu...3D35H%26sa%3DN

Bottom line is that the stomach has multiple blood supplies. It is very hard to disrupt them. When we did a Nissan fundoplication the surgeon would divide the short gastrics without any problems. There is a diagram of the blood supply in the middle of the page here:
http://en.wikipedia.org/wiki/Stomach


David Carpenter, PA-C

You have the coolest visuals! Very easy to read and understand! Thanks!