Page 13 - Read Online

M’Harzi et al. Mini-invasive Surg 2019;3:27 I http://dx.doi.org/10.20517/2574-1225.2019.22 Page 3 of 7

We are analyzing and comparing the risk of metaplasia (BE) and/or EA in OAGB and EJ rat models with
[8]
a follow-up of 30 weeks . The study is currently in progress but we decided to communicate the different
surgical techniques that we used to share our experience with scientists and the bariatric community.

METHODS
The study complied with European Community guidelines and was approved by the ethics committee
(Comité d’éthique en expérimentation animale n°18-115). Female and male Wistar rats aged 7 weeks and
weighing 250 g were used.

Preoperative care and anesthesia
Rats were fasted overnight before operation. Anesthesia was given by inhalation with isoflurane. Standard
[9]
aseptic procedures were used throughout .
Materials
Our equipment included an anesthesia workstation, Prolene 7/0 and Vicryl 3/0 sutures, a self-retaining
retractor, curve dressing forceps, curved scissors, a micro needle order and needle order, scalpel handle,
crile and an optical magnification system, an endo GIA 45-mm staple gun with purple cartridge
(Medtronic) and a TA-DST 30-mm-3.5-mm stapler (Covidien).

Rat position and exposition
The rat was positioned supine, feet spread apart, abdomen shaved. After laparotomy, the lateral banks were
removed with a self-retaining retractor and a suture was suspended at the xyphoid.

OAGB surgeries
After retraction of the liver, the stomach was isolated [Figure 1A]. Loose gastric connections to the spleen
were released along the greater curvature, and the suspensory ligament supporting the upper fundus was
severed [Figure 1B]. A vicryl suture was passed behind the esophagus. Then, the gastric artery and the
esophagus were separated [5,10] .

The gastric pouch
The forestomach was resected using an endo GIA 45-mm staple gun with purple cartridge (Medtronic;
Figure 1C-E). The esogastric junction was then dissected and the vascular supply isolated in this region.
The stapler TA-DST 30 mm-3.5 mm (Covidien) position was delimited between the esophagus and the left
gastric artery using the wire previously placed positioned in a parallel line with the transection line of the
forestomach, and the gastric pouch created [Figures 1F and G].

Omega limb
The small intestines were run distally from the pylorus for 25 cm. We recommend using a premeasured
suture for this [Figure 1H]. Curved scissors were used to create a 3-mm jejunostomy on the anti-mesenteric
margin of bowel. The jejunum was then anastomosed to the gastric pouch 25 cm from the pylorus [Figure 1I].

Hand-sewn gastro-jejunostomy
The loop of bowel was identified was moved gently to the gastric pouch. A 3-to-4-mm gastrostomy was
made on the gastric pouch [Figure 1I]. The anastomosis was performed manually with 7-0 Prolene running
sutures. We began with the corner points on both sides of the anastomosis [Figure 1J]. When the anterior
running suture was complete, we turned the gastrojejunal block and then completed the posterior running
suture. The suture took serosa on the esophagus and the gastric tube. After replacing the gastrojejunal
block [Figure 1K], we wrapped the anastomosis in the omentum. One milliliter of saline was then poured
intraperitoneally.