A series of four clinical photographs (A-D) demonstrating the intraoperative steps of a proximal gastrectomy and remnant stomach preparation. Panel A shows the stomach exteriorized through a mini-laparotomy incision, with the intended transection line marked across the corpus using Gentian Violet ink. Panel B illustrates the application of an endoscopic linear stapler along the marked line to achieve gastric transection. Panel C depicts the subsequent reinforcing of the stapled stump of the remnant stomach with seromuscular hand-sewn sutures using a needle driver. Panel D shows the creation of a small enterotomy on the anterior wall of the remnant stomach, located approximately 45 mm distal to the proximal stump, to facilitate subsequent esophagogastric reconstruction. The images highlight surgical techniques for gastric cancer management, focusing on resection margins and preparation for anastomosis. Key landmarks include the greater and lesser curvatures of the stomach and the surrounding omental tissue.

Educational medical composite depicting steps of an intracorporeal esophagojejunostomy following total gastrectomy. Figure A is a clinical laparoscopic photograph showing a 60-mm linear stapler being fired to convert two enterotomies into a single common entry hole, facilitating a functional end-to-end esophagojejunal anastomosis. Surgical graspers are visible manipulating the esophagus and jejunal limb, which is marked with red surgical dye. Figure B is a schematic diagram illustrating the resection phase, showing the stomach being detached along a primary resection line (black) and an optional proximal jejunal resection line (blue). Figure C is a schematic of the reconstructive phase, specifically a side-to-side jejunojejunostomy. Labels 'P' (proximal) and 'D' (distal) indicate the orientation of the bowel loops. The diagrams highlight the 'π-shaped' configuration of the anastomosis. This content is designed for surgical education regarding robotic-assisted or laparoscopic gastric bypass and oncological reconstruction techniques.

This composite figure illustrates the surgical steps and radiological outcomes of Vertical Sleeve Gastrectomy (VSG) and Roux-en-Y Gastric Bypass (RYGB) procedures using a rat model. (A-B) Baseline anatomy of the stomach, identifying the rumen (forestomach), fundus, and antrum via clinical photography and contrast radiography. (C-E) Intraoperative VSG steps demonstrating the use of a metallic staple gun for vertical resection of the rumen and fundus to reduce gastric volume. (F) Post-VSG radiography showing a tubularized gastric pouch. (G-J) RYGB procedure, including the creation of a small gastric pouch, gastro-jejunal anastomosis (G, H), and end-to-lateral jejuno-jejunal anastomosis (I, J) to form the alimentary limb, verified by contrast opacification. (K) Macroscopic necropsy view and radiographic insert (star) depicting a gastric fistula, a significant post-operative complication. The visual material details bariatric surgical techniques, gastrointestinal anastomotic structures, and radiographic verification of altered anatomy and complications such as leaks.

This composite of four laparoscopic intraoperative clinical photographs (A-D) illustrates key steps in a bariatric/metabolic surgical procedure, specifically a sleeve gastrectomy followed by a duodenoileal anastomosis. Panel A shows the initial duodenal transection using a linear surgical stapler distal to the pylorus. Panel B demonstrates the sequential firing of a laparoscopic linear stapler along the greater curvature of the stomach to create the gastric sleeve, with visible staple lines and gastric tissue compression. Panel C depicts the first row of a manual or stapled duodenoileal anastomosis, showing the approximation of the proximal duodenum to a loop of ileum. Panel D displays the final aspect of the end-to-side duodenoileal anastomosis, characterized by a secure, sutured junction between the digestive segments with healthy, well-perfused tissue margins and minimal surgical bleeding. The images highlight critical anatomical landmarks including the pyloric region, duodenum, and ileum, emphasizing surgical techniques for tissue resection and reconstruction in laparoscopic gastrointestinal surgery.

This composite educational material consists of an intraoperative clinical photograph (6a) and a corresponding surgical anatomical diagram (6b) illustrating a complex abdominal surgical revision. Image 6a displays the intraoperative findings in a patient with a prior Billroth II gastric reconstruction, specifically highlighting significant adhesions and fibrotic tissue at the site of the gastrojejunal anastomosis. The surgical field shows the interface between the stomach remnant and the jejunal loop with visible scar tissue and anatomical distortion. Diagram 6b provides a schematic representation of the upper gastrointestinal anatomy, including the liver, biliary tree, stomach, and pancreas. A red line in the diagram demarcates the intended excision range for a subtotal stomach-preserving pancreatoduodenectomy (SSPPD). This boundary indicates the planned resection of the previous gastrojejunal anastomosis and the pancreatic head to address a secondary pathology (IPMN). The visual set demonstrates the challenges of reoperative abdominal surgery, specifically the management of previous anastomotic sites and the planning of complex biliary-pancreatic reconstructions in the setting of prior gastrectomy.

This laparoscopic clinical photograph illustrates a Billroth I reconstruction featuring a delta-shaped anastomosis. The image shows the surgical joining of the remnant stomach and the duodenum following a partial gastrectomy. The anastomosis site is centrally located, characterized by a visible line of interrupted blue sutures and metallic surgical clips that approximate the pink, vascularized tissue edges. To the left, a metallic surgical grasper is seen manipulating the tissue, while a white stabilization device or retractor is positioned superiorly. The surrounding anatomy includes the liver (dark red/brown organ) and omental fat. This image demonstrates the intraoperative appearance of a functional gastrointestinal anastomosis, focusing on tissue viability, suturing technique, and the use of mechanical stapling/clipping devices in oncological gastric surgery.

This clinical photograph shows an intraoperative open view of a surgical field during a Billroth I (B1) gastroduodenostomy, a common reconstruction technique following a distal subtotal gastrectomy. The liver is visible at the top of the field, retracted superiorly to provide access. Below the liver, the gastric stump is being prepared for anastomosis. Surgical clamps and forceps are seen manipulating the stomach and duodenal tissues to ensure proper alignment and tension-free connection. The surrounding area shows visceral fat (omentum) and evidence of surgical dissection, including minor hemostatic changes. The image illustrates the anatomical relationship between the gastric remnant and the duodenum in the upper abdomen. This visual is typical for educational materials focused on gastrointestinal surgical oncology, specifically the management of tumors located in the lower-third or antral segment of the stomach where distal resection is indicated.