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

2. 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.

7. CONCENTRIC CONTRACTION

9. INCISURA ANGULARIS
PYLORUS
1ST PART DUODENUM

10. 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 ,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.

11. HELICOBACTER

12. EROSIVE GASTRITIS

13. DRUG ULCER

14. GIST

15. CARCINOMA

16. 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):

17. INCISURA ANGULARIS AFTER SG

18. INCISURA ANGULARIS AFTER SG

19. STENOSIS AT INCISURA ANGULARIS

20. KINK AT INCISURA ANGULARIS AFTER SLEEVE GASTRECTOMY

21. LEAK
STENOSIS

22. GASTRIC STENOSIS AT INCISURA ANGULARIS WITH A DIVERTICULUM

23. STRICTURE AT INCISURA ANGULARIS WITH PROXIMAL DILATATION AFTER SG

24. 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):
-DAPRI G, ET AL , LAPAROSCOPIC SEROMYOTOMY FOR LONG STENOSIS AFTER SLEEVE GASTRECTOMY WITH OR WITHOUT DUODENAL SWITCH.
J OBES SURG 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 Mar;26(3):

25. ENDOSCOPIC DILATATION

26. STENT

27. THANK YOU