THE ROLE OF THE INCISURA ANGULARIS IN SLEEVE GASTRECTOMY

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Presentation transcript:

THE ROLE OF THE INCISURA ANGULARIS IN SLEEVE GASTRECTOMY By Dr. IBRAHIM GALAL Professor of Surgery Faculty of Medicine, Cairo University, Egypt

THE INCISURA ANGULARIS IS THE SHARP NOTCH THAT IS PRESENT ON THE LESSER CURVATURE OF THE STOMACH 4/5 cm PROXIMAL TO THE PYLORUS. THE INCISURA ANGULARIS IS A PERMANENT FEATURE WHICH DOES NOT CHANGE WITH PERISTALSIS. AT THIS POINT THE BODY OF THE STOMACH STATRS TO NARROW TO FORM THE PYLORIC CHANNEL. ESSENTIAL REVISION NOTES FOR INTERCOLLEGIATE MRCS.: BOOK. 2, ANATOMY OF THE STOMACH,SECTION 3,PAGE 75. STOMACH,NORMAL GROSS ANATOMY. REVIEWERS: ELLIOT WEISENBERG, M.D.

CONCENTRIC CONTRACTION

INCISURA ANGULARIS PYLORUS 1ST PART DUODENUM

THE INCISURA ANGULARIS IS CONSIDERED TO BE A TYPICAL COMMON SITE FOR MOST OF GASTRIC DISORDERS SUCH AS HELICOBACTER COLONIZATION, GASTRITIS, GLANDULAR ATROPHY, INTESTINAL METAPLASIA, GASTRIC ULCER, GEST AND GASTRIC CARCINOMA. ISAJEVS S et al, THE EFFECT OF INCISURA ANGULARIS BIOPSY SAMPLING ON THE ASSESSMENT OF GASTRITIS STAGE. EUR J GASTROENTEROL HEPATOL. 2014 ,MAY;26(5):510-3. ERIKSSON NK et al, THE CLINICAL VALUE OF TAKING ROUTINE BIOPSIES FROM THE INCISURA ANGULARIS DURING GASTROSCOPY. ENDOSCOPY 2005 JUN;37(6):532-6.

HELICOBACTER

EROSIVE GASTRITIS

DRUG ULCER

GIST

CARCINOMA

IN ADDITION, GASRIC STENOSIS AFTER SLEEVE GASTRECTOMY USUALLY OCCURS AT THE INCISURA ANGULARIS. IT USUALLY PRESENTS BY VARIOUS GRADES OF NARROWING RANGING FROM MILD FOOD INTOLERANCE ( 70%) TO COMPLETE OBSTRUCTION(0.6 %). Parikh A et al, Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese. Surg Endosc. 2012 Mar;26(3):738-46.

INCISURA ANGULARIS AFTER SG

INCISURA ANGULARIS AFTER SG

STENOSIS AT INCISURA ANGULARIS

KINK AT INCISURA ANGULARIS AFTER SLEEVE GASTRECTOMY

LEAK STENOSIS

GASTRIC STENOSIS AT INCISURA ANGULARIS WITH A DIVERTICULUM

STRICTURE AT INCISURA ANGULARIS WITH PROXIMAL DILATATION AFTER SG

MANAGEMNT OPTIONS 1-SPONTANEOUS RESOLUTION 2-ENDOSCOPIC DILATATION/STENTING 3-SEROMYOTOMY/ STRICTROPLASTY 4-ROUX-EN-Y GASTRIC BYPASS. -VILALLONGA R.ET AL, LAPAROSCOPIC MANAGEMENT OF PERSISTENT STRICTURES AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY. OBES SURG. 2013 OCT;23(10):1655-61. -DAPRI G, ET AL , LAPAROSCOPIC SEROMYOTOMY FOR LONG STENOSIS AFTER SLEEVE GASTRECTOMY WITH OR WITHOUT DUODENAL SWITCH. J OBES SURG. 2009 APR; 19(4):495-9 -PARIKH A. ET AL, Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese. SURG ENDOSC. 2012. Mar;26(3):738-46.

ENDOSCOPIC DILATATION

STENT

THANK YOU