Gastrojejunal anastomosis
in Roux-en-Y Gastric Bypass (RYGB)

EDITORS : Michel Vix (MD), Marius Nedelcu (MD), Bernard Dallemagne (MD)
Chief Editor : Jacques Marescaux (MD, FACS, Hon. FRCS, Hon. FJSES)

Objectives

To illustrate and explain different potential techniques to perform the gastrojejunal anastomosis during RYGB
To address common problems encountered intraoperatively with each of these techniques and to emphasize different tips and tricks to prevent them
To know how to minimize or to treat common postoperative complications such as leakage, stenosis or anastomotic ulcer

State of the art

Michel Vix, MD
Hôpitaux Universitaires de Strasbourg, France
Marius Nedelcu, MD
Sfantul Constantin Hospital, Romania
dehbi ali moulay, ALGERIA
2016-12-15 00:05
superb videos thank you
GIORGI GUMBARIDZE, BELARUS
2016-11-16 15:47
good job
marcelo palma, ARGENTINA
2016-04-23 22:05
Realmente es un muy buen trabajo.
Elfrida Salihi, SWITZERLAND
2016-04-18 13:01
very good job!!!
Marcelo Protasio, BRAZIL
2016-03-10 12:48
Great stuff!
Kakhaber Kashibadze, GEORGIA
2016-02-07 19:20
good job. thanks alot
feroze mir, SAUDI ARABIA
2015-12-27 16:37
Great stuff
feroze mir, SAUDI ARABIA
2015-12-27 16:37
Great stuff
feroze mir, SAUDI ARABIA
2015-12-27 16:37
Great stuff
kurikala raghu, INDIA
2015-12-13 08:01
Good presentation ,but pronunciation disturbed it a little,never mind
allam gamea, EGYPT
2015-12-12 21:41
very nice job thanks alot
Rafael Quezada Martínez, EL SALVADOR
2015-12-03 19:30
I Gynecologist, but the presentation is good. Thank you for sharing knowledge.
Saeed Alshomimi, SAUDI ARABIA
2015-12-03 10:35
Informative summery
mohamed hassan, EGYPT
2015-12-03 08:58
Thank you
Sebahattin Destek, TURKEY
2015-12-03 05:37
Very nice.Thank you.
Guillermo Diaz, EL SALVADOR
2015-12-03 04:26
Excellent presentation, Thanks for teaching so great
fernando andrade, BRAZIL
2015-12-02 19:17
Thank you!!!
elif özçimen, TURKEY
2015-12-02 15:51
thanks for study
Romulo Marcelo Barba Rodríguez, ECUADOR
2015-12-02 05:08
Thanks!
Arslan KARAMAN, TURKEY
2015-12-01 22:41
thank you for thisRYGB
ALI BENDJABALLAH, ALGERIA
2015-12-01 20:47
verry nice explination thank you
Sabir Gabibov, RUSSIAN FEDERATION
2015-11-17 06:23
хорошая презентация спасибо
Mohammed Mustafa Hassan, EGYPT
2015-11-13 14:55
great
nicola morelli, ITALY
2015-06-25 18:55
Very nice technicalities. Thank you.
jagdishkumar patel, INDIA
2015-06-24 20:17
Fantastic....!
costica COSMAN, ROMANIA
2015-04-05 07:56
FELICITARI PT.MARIUS... SI SALUTARI DE LA IASI
Victor Cuevas, MEXICO
2015-03-07 18:17
Thanks!
SAM CUNANAN, PHILIPPINES
2015-02-05 00:29
Great presentation ! Thanks !
Andre Risha, BELGIUM
2015-01-21 22:34
Reciting lesson!
JAVIER MAYOR, PERU
2015-01-05 01:09
Congratulations... it's excellent!!!
Rene Gordillo, ECUADOR
2014-12-29 03:45
Very good presentation, Thanks.
Mohamed Abdou, UNITED STATES
2014-12-28 11:54
The dream come true I'm so pleased
Tha Anh, VIET NAM
2014-12-24 08:16
Good. Thanks
roberto edde, VENEZUELA
2014-12-23 16:23
Good presentation. Thanks for that useful information.
ashraf obaid, ISRAEL
2014-11-21 04:24
Great and wonderful
Marcio Almeida, BRAZIL
2014-09-19 20:51
Perfeita a tecnica.
zakaria kraly, EGYPT
2014-08-06 12:07
Zakaria kraly ,Ismailia Egypt: Being an excellent surgeon does not mean to be a good narrator specially with a less than optimum audio. Extremely beneficial teaching stuff,thanks
Sanjib Kumar Mohanty, CAYMAN ISLANDS
2014-08-04 22:50
Wonderful way of presenting a most complex operation.
Excellent.
abdulelah sindi, SAUDI ARABIA
2014-08-01 22:32
Very detailed and illustrative with good concomitant videos
JUAN CARLOS QUINTANA, MEXICO
2014-07-30 08:52
Very good. Thanks.\nExcellent.
DAVID JARAMILLO, ECUADOR
2014-07-24 17:34
VERY GOOD, CONGRATULATIONS DR. nADELCU
Jose Luis Sampaio Martins, BRAZIL
2014-07-23 00:03
Congratulation for offering very important informations
gerardo peña, MEXICO
2014-07-22 02:46
It's interesting surgery
Alberto Kabalan, COLOMBIA
2014-07-21 13:18
Very good
Abdugadir M. Abdulrahman, LIBYAN ARAB JAMAHIRIYA
2014-07-21 02:28
Thank you\n
Haci vural Soyer, TURKEY
2014-07-21 01:03
Thanks. Good presentation
Pedro Ivo Gama, BRAZIL
2014-07-21 00:56
Very good presentation
Erick Rolando Rocha Guevara, MEXICO
2014-07-20 20:24
Congratulations for your excellent presentation. Thanks a lot!
valerio guevara, NICARAGUA
2014-07-20 02:18
Amazing!! Thank you for do this for us.
JOSE AUGUSTO CYRINEU MARTINS, BRAZIL
2014-07-19 18:47
Excellent! \n
Grama Florin, ROMANIA
2014-07-19 18:35
Very nice presentation Marius!Congrats!!!
Francisco Cardoza-Macias, MEXICO
2014-07-19 17:10
Excellent!! Very didactic and very well presented material. Thank you
Amr Elwani, EGYPT
2014-07-19 16:35
Good morning ,, I think ,, it is a excellent approach ,we will try it and send my results

Gastrojejunostomy techniques

oscar gomez, COLOMBIA
2016-04-28 14:59
Excelent videio
arturo martinez medrano, MEXICO
2016-02-16 01:19
congratulations
allam gamea, EGYPT
2015-12-12 21:44
good job thanks
Pablo Morató, BOLIVIA
2015-12-10 03:02
Congratulations
Farhan Ansari, SAUDI ARABIA
2015-12-04 14:24
It's a great feeling to connect with so many surgeons through cyberspace as we all speak the same language. "Surgery".... For the same purpose
dimitris papadimitriou, GREECE
2015-12-03 23:27
You always looking for new ways to make the surgeon's life more comfort. Congratulations
dimitris papadimitriou, GREECE
2015-12-03 23:27
You always looking for new ways to make the surgeon's life more comfort. Congratulations
dimitris papadimitriou, GREECE
2015-12-03 23:27
You always looking for new ways to make the surgeon's life more comfort. Congratulations
dimitris papadimitriou, GREECE
2015-12-03 23:27
You always looking for new ways to make the surgeon's life more comfort. Congratulations
dimitris papadimitriou, GREECE
2015-12-03 23:27
You always looking for new ways to make the surgeon's life more comfort. Congratulations
Abdellah Khellaf, ALGERIA
2015-12-03 18:39
Thank you
elif özçimen, TURKEY
2015-12-02 15:51
thanks
ALI BENDJABALLAH, ALGERIA
2015-12-01 20:48
I was very impressed it's imaging
surgery is a very great art. good continuation
sergio acoltzi, MEXICO
2015-11-24 19:20
very nice explanation, thank you!
SANTIAGO GOMEZ, COLOMBIA
2015-11-23 17:54
Very good explanation for creating the anastomosis
VUGAR SULEYMANOV, CANADA
2015-11-17 17:52
Good job
ismail biri, TURKEY
2015-11-16 15:06
perfect
christian romero, VENEZUELA
2015-11-15 15:48
excellent video, great quality and very well directed into the important anatomical references, thank you.
vasilescu alin mihai, ROMANIA
2015-11-11 08:33
Thank you. Very clear. Congratulation!
Luis E. Medina Fernández, PERU
2015-11-10 22:24
Very good!
Cristian Zlate, ROMANIA
2015-11-10 18:46
nice! well done! very explicate!
sameer gupta, INDIA
2015-11-10 08:55
Thanx for nice video.
Ignacio Neri, MEXICO
2015-10-22 21:07
Thank you very clear
abdel jabbar samara, SWITZERLAND
2015-10-18 07:01
Great
Fathi Alrasheed, GERMANY
2015-09-26 02:23
Very nice, many thanks
datta ram, INDIA
2015-07-25 13:04
Wonderful technique and well demonstrated\n\nMy congratulations
Murat CILEKAR, TURKEY
2015-07-20 10:48
This is so easy and the best technique of obesity surgery. Congratulations\nMurat CILEKAR TURKEY
Julio Mariano da Rocha, BRAZIL
2015-01-21 01:16
Quite didatic and clear surgical demonstration. Interesting anastomotic technique
Congratulation
Metin Yeşiltaş, TURKEY
2014-09-18 17:29
This is the best technique of obesity surgery I have ever seen so far! Well Done.
Jose Luis Sampaio Martins, BRAZIL
2014-07-23 00:15
I do the anastomosis in 2 plans
Sergey Minaev, RUSSIAN FEDERATION
2014-07-20 14:43
Good job! My congratulations!

Adverse effects

CARLOS FERNANDEZ QUESADA, SPAIN
2016-11-23 00:57
admirable la generosidad, humildad del equipo quirúrgico compartir estas imágenes así como la excelente capacidad de resolución ante una situación imprevista.
Gracias de nuevo
ALI BENDJABALLAH, ALGERIA
2015-12-01 21:02
I attached my opinion to that of Dr. OBADA is feasible by taking on more precautionary. Thank you for this wonderful work.
Nitu Valentin, FRANCE
2015-10-26 10:15
Bravo. Nice
obada alqudah, JORDAN
2014-09-19 20:16
I think that at the time of accidental gastric perforation, surgeon can put amvit (with suture, as marker) inside gastric pouch, before continuing stapling stomach
and bypass trans-oral step of amvil placement
Juan J Gonzalez, SPAIN
2014-07-20 17:03
We are very confident with the transoral technique (Auto-Suture CEEA 28), with more than 400 cases without major problems, but in three patients we had serious difficulties to pass through the anvil at the middle esophagus and we need and esophagoscopy to mobilize it. In two additional ones it was near impossible to return the anvil at the standard position, before to adjust the cartridge. An expert anesthesiologist is capital, because very tiny details like the position of the anvil when it pass through the mouth is essential

Complications

Ali Ghasemi, IRAN, ISLAMIC REPUBLIC OF
2016-11-11 22:01
I see some videos about bariatric surgery.they are very good and are yousfull for me.
александр степанов, RUSSIAN FEDERATION
2016-03-02 17:22
Просто супер!
Arben Beqiri, ALBANIA
2015-12-04 15:58
excellent step by step approach. detailed problem resolving techniques and explanations. Very helpful.
thank you for being there for us .
elif özçimen, TURKEY
2015-12-02 15:52
best wishes for your resouce
ALI BENDJABALLAH, ALGERIA
2015-12-01 21:09
thank you for this explanations
Victor Manuel Vasquez Morales, PERU
2015-06-02 07:51
Excellent, everything is ok\n
Rene Gordillo, ECUADOR
2015-01-21 06:55
Thank you so much it is unvaluable
Manuel Rodrigo Prieto Aldape, MEXICO
2014-09-22 00:22
It is a great resource of information !!! It's a treasure, it will help me and my patients a lot !
Gustavo Bastidas, PERU
2014-07-23 05:32
Excellent explanation. Thanks
girish juneja, UNITED ARAB EMIRATES
2014-07-20 12:52
Excellent interactive way of teaching,\nwebsurg is the best

Authors

Marius Nedelcu, MD
Sfantul Constantin Hospital, Romania
Michel Vix, MD
Hôpitaux Universitaires de Strasbourg, France
Didier Mutter, MD, PhD, FACS
Hôpitaux Universitaires de Strasbourg, France
Bernard Dallemagne, MD
Hôpitaux Universitaires de Strasbourg, France
Jacques Marescaux, MD, FACS, Hon FRCS, Hon FJSES, Hon FASA, Hon APSA
Hôpitaux Universitaires de Strasbourg, France
Alfons Pomp, MD, FACS, FRCSC
New York-Presbyterian Hospital/Weill Cornell Medical Center, United States
Kelvin Dwight Higa, MD, FACS, FASMBS
University of California San Francisco, United States
Jacques Himpens, MD
Hôpital Universitaire St Pierre, Belgium
John Morton, MD, MPH, FACS
Stanford Hospital and Clinics, United States
Garth Ballantyne, MD, MBA, FACS, FASCRS
Lawrence and Memorial Hospital, United States
Daniel Herron, MD, FACS
Mount Sinai Hospital, United States
Ludovic Marx, MD
Hôpitaux Universitaires de Strasbourg, France
Antonio D'Urso, MD, PhD
Hôpitaux Universitaires de Strasbourg, France
Ghassan Sojod, MD
Hôpitaux Universitaires de Strasbourg, France
Keng-Hao Liu, MD
Chang Gung Memorial Hospital, Taiwan
Diego Varela, MD
Hôpital Civil, France
Federico Costantino, MD
Hôpitaux Civils de Colmar, France

References

  1. Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic Gastric Bypass, Roux en Y: Preliminary Report of Five Cases. Obes Surg 1994;4:353-7.
  2. Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000;232:515-29.
  3. Roberts K, Duffy A, Kaufman J, Burrell M, Dziura J, Bell R. Size matters: gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Endosc 2007;21:1397-1402.
  4. Owens M, Sczepaniak J. Size really does matter-role of gastrojejunostomy in postoperative weight loss. Surg Obes Relat Dis 2009;5:357-61.
  5. Heneghan HM, Yimcharoen P, Brethauer SA, Kroh M, Chand B. Influence of pouch and stoma size on weight loss after gastric bypass. Surg Obes Relat Dis 2012;8:408-15.
  6. Nguyen NT, Goldman C, Rosenquist CJ, Arango A, Cole CJ, Lee SJ, Wolfe BM. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 2001;234:279-89; discussion 289-91.
  7. Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y-500 patients: technique and results, with 3-60 month follow-up. Obes Surg 2000;10:233-9.
  8. Wittgrove AC, Endres JE, Davis M, et al. Perioperative complications in a single surgeon's experience with 1,000 consecutive laparoscopic Roux-en-Y gastric bypass operations for morbid obesity. Obes Surg 2002;12:457-8.
  9. Higa K, Ho T, Boone K. Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Tech 2001;11:377-82.
  10. Champion JK, Hunt T, DeLisle N. Laparoscopic vertical banded gastroplasty and Roux-en-Y gastric bypass in morbid obesity. Obes Surg 1999;9:123-44.
  11. DeMaria EJ, Sugerman HJ, Kellum JM, et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 2002;235:640-7.
  12. Spaulding L. The impact of small bowel resection on the incidence of stomal stenosis and marginal ulcer after gastric bypass. Obes Surg 1997;7:485-7.

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