Minimally Invasive Bariatric Surgery Service
Drs. Quilici, Tovar and McVay

 

Laparoscopic Gastric Bypass with Roux Y Limb

LapGBRYTechniqueRisksImpact
Side EffectsConcernsHospitalDiet

The Technique

The laparoscopic gastric bypass with Roux en Y Reconstruction combines a restrictive and a malabsorptive procedure. In plain terms, the sustained weight loss is accomplished by creating a small stomach with a (non-banded) outflow and a 75cm portion of the small bowel with diminished absorption (see diagram).

It is accomplished as follows (technical breakdown):

  • The Laparoscopy: After the patient is put to sleep and positioned properly on the operating table, CO2 gas is insufflated in the intra-abdominal cavity (abdomen). Six small incisions are made and trocars (special access devices) are placed. The intra-abdominal cavity is visualized and checked with a special camera (laparoscope).

 

  • The Creation of the Roux en Y Limb: The first portion of the small bowel is found and checked. It is also cut with a cutting-stapling device (ENDOGIA). A limb or portion of jejunum is measured (75cm) and the small bowel is re-attached together using the same stapling device (the entero-enterostomy). A tunnel is created in the posterior aspect of the abdomen and the Roux en Y limb is passed upward toward the new gastric pouch. The tunnel is tightly closed around the Roux en Y limb with sutures.

  • The Creation of the Small Gastric Pouch: The stomach is checked and mobilized (some of its attachments are cut). A special tube (inserted through the nose into the stomach) is used to size the capacity of the gastric pouch to be created. The stomach is cut and stapled (simultaneously with a surgical stapling device or ENDOGIA) to create a small (15 to 20 ml) gastric pouch. The rest of the stomach is left intact.

  • Attaching the Roux Limb to the Gastric Pouch: Using a special technique and surgical stapling device the Roux en Y limb is attached to the new gastric pouch (the gastro-enterostomy). This is the most delicate portion of the procedure.

  • Checking the Integrity of the Procedure: The attachment of the stomach to the Roux en Y limb is checked by insufflating high pressure air in the small gastric pouch and checking for leaks.

 

  •  Placing the Drain: A drain is left next to the gastro-enterostomy and will exit through the stomach of the patient.

 

  • Associated Procedures and Techniques: If your surgeon has decided to perform another surgical procedure at the same time such as a cholecystectomy (removal of the gallbladder), it will performed at the same time.