Minimally Invasive Surgery (MIS) for Ileal Interposition
Authors: Dr. R. Padmakumar and Dr. Madhukar Pai
Consultant Metabolic Surgeons
Sunrise Hospital, Cochin, Kerala, India
Ileal Interposition is a surgery getting established as the procedure of choice in non-obese diabetics.
The complexity of the procedure makes it difficult to be practiced by more number of surgeons.
We have successfully adopted a MIS technique to complete the procedure with the following modifications:
- The modified sleeve will be completed by an above umbilical vertical incision of 2 cm for the endostaplers.
This is instead of a high placed left sided horizontal incision (used for the specimen retrieval also).
- Upon completion of the modified sleeve the vertical incision is extended to umbilicus making it 5 cm long.
The specimen is removed and the small intestine is brought outside segment wise.
- First the markings for small intestinal divisions are made at 30 cm from D.J and 30 cm proximal to the I/C and one
between the two almost at equidistant from the proximal and distal.
- Hand held Harmonic scalpel and cautery will be used for mesenteric and bowel division.
- Hand sewn anastomosis, end-to-end is made at all 3 positions of interposition using 3-0 Vicryl and silk.
- The mesenteric defects closed with silk after each anastomosis.
- Each segment is placed back on closure of mesentery to avoid venous congestion.
- Drain brought out through the 1 cm incision made for telescope.
- Abdomen wound closed with Prolene and Vicryl subcuticular.
Advantages of this technique:
- The number of cut ends reduced.
- Weak spots reduced.
- No use of staplers for small intestinal anastomosis.
- Easy to perform
- Time for procedure reduced at least by 1-½ to 2 hours.
- Reduce cost considerably (avoids 9 to 12 catridges.)
Having a small cut in the umbilical area.
This procedure is an innovative, mimicable alternative to completely laparoscopic metabolic surgery in the non-obese group.