Enhanced techniques for insertion and extraction of a bougie during gastroplasty
An assembly including a bougie and a sheath for use in performing a gastroplasty for dividing a stomach of a patient into a sleeve receiving food and a bypass portion. The bougie includes an elongated body having a segment being shaped to follow a lesser curve of the stomach, and an extension member being movable within the stomach for positioning a distal portion thereof away from a gastroesophageal junction of the stomach and to define a fluid passage between the sleeve and the bypass portion. The sheath has an elongated main lumen in which the bougie is inserted and the sheath is translatable along the bougie to selectively expose the extension member of the bougie to perform its guiding action, or hide the extension member to ensure secure displacement of the bougie within the stomach and along the oesophagus.
1. A method of performing a sleeve gastroplasty using an assembly comprising a bougie having a guiding segment for forming the sleeve and a sheath comprising a tubular body for securing at least a portion of the guiding segment, the method comprising: inserting the bougie into a stomach of a patient until the guiding segment is positioned along a lesser curve of the stomach; displacing the tubular body with respect to the bougie in a backward direction to expose the guiding segment; joining opposed walls of the stomach along a junction line in response to a position of the guiding segment in the stomach to form the sleeve within the stomach; displacing the tubular body with respect to the bougie in a forward direction to cover the guiding segment; and removing the bougie from the stomach.
2. The method of claim 1 , comprising extending the portion of the guiding segment outwardly from the lesser curve of the stomach until a distal end of the portion of the guiding segment is located proximal to a gastroesophageal junction, and wherein the joining of the opposed walls of the stomach is performed along an inner edge of the guiding segment until reaching the distal end thereof, thereby defining a fluid passage between the sleeve and a bypass portion in a top region of the stomach.
3. The method of claim 2 , comprising extending the portion of the guiding segment outwardly from the lesser curve of the stomach until a distal end of the portion of the guiding segment is located proximal to a gastroduodenal junction, and wherein the joining of the opposed walls of the stomach is performed along an inner edge of the bougie until reaching the distal end thereof, thereby defining a fluid passage between the sleeve and a bypass portion in a distal region of the stomach.
4. The method of claim 1 , wherein the displacement of the tubular body with respect to the bougie in the backward direction to expose the guiding segment actuates the extension of the portion of the guiding segment.
5. The method of claim 1 , comprising retracting the portion of the guiding segment in alignment with the lesser curve of the stomach before displacing the tubular body with respect to the bougie in the forward direction to cover the guiding segment.
6. The method of claim 1 , comprising controlling movement of the portion of the guiding segment with at least one wire or magnet cooperating with the distal end of said portion.
7. The method of claim 1 , wherein the tubular body comprises a distal tube segment and a proximal tube segment, and wherein displacing the tubular body comprises backward translation of the proximal tube segment to expose the portion of the guiding segment, and forward translation of the distal tube segment to hide the portion of the guiding segment.
8. The method of claim 1 , wherein displacing the tubular body is performed from an oral cavity of the patient by direct pushing and/or pulling of a wire system operatively connected to the tubular body.
9. The method of claim 1 , wherein displacing the tubular body is performed from an oral cavity of the patient by direct pushing or pulling of the sheath itself.