Checking mobility of bougie 35 3.54 [3.03 - 4.06] 31 3.32 [2.77 - 3.88] Waiqng 15 seconds between closing and firing stapler 35 2.89 [2.48 - 3.29] 31 2.87 [2.44 - 3.3] Checking 15 second duraqon by scrub nurse 35 1.74 [1.36 - 2.13] Excluded Detachment of posterior a~achments stomach 35 3.2 [2.77 - 3.63] 31 3.58 [3.16 - 4] Advised Dissecqng angle of His ventral side 35 3.66 [3.27 - 4.05] 31 3.68 [3.28 - 4.07] Advised Dissecqng Belsey’s fat pad a 35 2.46 [2.05 - 2.87] Excluded Detaching stomach from le crus with goldfinger 35 2.34 [1.85 - 2.84] Excluded Final stapling pouch 35 4.69 [4.47 - 4.9] Key step Haemostaqc checking of stapleline 35 4.29 [4 - 4.57] Key step Checking pouch by insufflaqon of air through bougie 35 1.91 [1.47 - 2.36] Excluded Crea2on of biliopancrea2c limb and gastrojejunal anastomosis Determine length of biliopancreaqc limb b 34 3.74 [3.45 - 4.02] 31 3.74 [3.44 - 4.04] Advised Li transverse colon 34 3.76 [3.34 - 4.19] 31 3.52 [3.08 - 3.95] Advised Idenqficaqon of Treitz' ligament 34 4.56 [4.3 - 4.82] Key step Measure jejunum starqng from Treitz' ligament b 34 4 [3.66 - 4.34] 31 4.1 [3.75 - 4.44] Key step Running the jejunum in a clockwise manner 33 4.15 [3.8 - 4.51] 31 4.06 [3.8 - 4.33] Key step Checking possibility tension free anastomosis 34 4.29 [4.02 - 4.57] Key step SpliÅng the greater omentum 34 2.24 [2.06 - 2.41] Excluded Creaqng a retrocolic defect 34 1.44 [1.17 - 1.72] Excluded Placement of support sutures 34 1.41 [1.14 - 1.68] Excluded Opening of the pouch 34 4.76 [4.55 - 4.98] Key step Opening jejunum 34 4.74 [4.52 - 4.95] Key step Stapled gastrojejunal anastomosis 34 4.62 [4.32 - 4.92] Key step Compleqng GJ anastomosis with sutures 34 4.56 [4.2 - 4.91] Key step Crea2on of alimentary limb and jejunojejunal anastomosis Determine length of alimentary limb b 34 3.79 [3.51 - 4.08] 31 3.81 [3.52 - 4.1] Key step Measuring small bowel starqng from pouch b 34 3.71 [3.36 - 4.06] 31 3.77 [3.48 - 4.07] Advised Running the small bowel in counter clockwise manner 34 3.65 [3.25 - 4.04] 31 3.81 [3.45 - 4.17] Advised Placement of support sutures on jejunum 34 1.38 [1.11 - 1.65] Excluded Opening efferent limb 34 4.62 [4.37 - 4.86] Key step Opening afferent limb 34 4.62 [4.37 - 4.86] Key step Stapled jejunojejunal anastomosis 34 4.62 [4.37 - 4.86] Key step Compleqng JJ anastomosis with sutures 34 4.32 [3.91 - 4.74] 31 4.16 [3.68 - 4.65] Key step 4 67 The crucial steps in gastric bypass and sleeve gastrectomy procedures
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