title: An analysis of surgical anatomy of the gastric fundus in bariatric surgery: why the gastric pouch expands? A point of technique.
abstract: In bariatric surgery, it is essential to completely release the Fundus in order to create a narrow gastric pouch. The upper part of the fundus is located above the omental bursa and is therefore retro-peritoneal. In order to release this completely, not only does the arterial supply to the fundus need to be divided to visualise the left diaphragmatic pillar, but the right attachment beginning at the left diaphragmatic pillar and running towards the fundus needs to be divided. This minimal dissection is compensated by further dissection at the level of the left diaphragmatic pillar and traction on the stomach from right to left during the final division stapling division process. The surgeon still has the impression of having released the posterior aspect of the Fundus, exposing the pillar of the diaphragm, although in fact part of the Fundus still remains adherent to the diaphragm and is therefore not released.
authors.affiliation: Department of Bariatric Surgery, CHU Hospital, Jean Monnet University, Saint Etienne, France. Electronic address: Radwankassir42@hotmail.Fr.
authors.forename: Radwan
authors.initials: R
authors.lastname: Kassir
authors.affiliation: Department of Bariatric Surgery, Clinique Chirurgicale Mutualiste de Saint Etienne, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Blanc
authors.affiliation: Department of Digestive Surgery, Clinique de la Chataigneraie, Beaumont, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Lointier
authors.affiliation: Department of Bariatric Surgery, CHU Hospital, Jean Monnet University, Saint Etienne, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Tiffet
authors.affiliation: Department of Bariatric Surgery, Clinique Chirurgicale Mutualiste de Saint Etienne, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Breton
authors.affiliation: Department of Bariatric Surgery, Archet 2 Hospital, University Hospital of Nice, Nice, France.
authors.forename: Imed
authors.initials: I
authors.lastname: Ben Amor
authors.affiliation: Department of Bariatric Surgery, Archet 2 Hospital, University Hospital of Nice, Nice, France.
authors.forename: Antonio
authors.initials: A
authors.lastname: Iannelli
authors.affiliation: Department of Bariatric Surgery, Archet 2 Hospital, University Hospital of Nice, Nice, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Gugenheim
mesh_terms: D050110:Bariatric Surgery; D003964:Diaphragm; D004210:Dissection; D005748:Gastric Fundus / Q000033:anatomy & histology* / Q000601:surgery*; D006801:Humans
keywords: Bariatric surgery; Diaphragmatic pillar; Gastric fundus; Hiatus hernia; Surgical anatomy