How does area not become necrotic?

Specialties Gastroenterology

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Specializes in LTC, Home Health.

I have a question that has been bothering me for years. In nursing school I asked many instructors how, during gastric bypass or banding, does the area sectioned off not become necrotic? They were not sure and had no answers. Can anyone tell me?

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Specializes in ER, ICU, Infusion, peds, informatics.

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.

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Specializes in LTC, Home Health.

That was my thinking but I was told all blood supply is cut off to the area in some surgeries depending on how the procedure was done.

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That was my thinking but I was told all blood supply is cut off to the area in some surgeries depending on how the procedure was done.

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?imgurl=http://www.bariatricinstituteky.com/images/stomach-stapling.gif&imgrefurl=http://www.bariatricinstituteky.com/procedure.html&h=263&w=224&sz=6&hl=en&start=2&um=1&tbnid=lnJCsBmrGorW4M:&tbnh=112&tbnw=95&prev=/images%3Fq%3Dgastric%2Bstapling%26um%3D1%26hl%3Den%26client%3Dfirefox-a%26rls%3Dorg.mozilla:en-US:official%26hs%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

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

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