A stepwise personal technique of RYGB with hand-sewn gastrojejunostomy
Epublication WebSurg.com, Oct 2017;17(10). URL: http://websurg.com/doi/vd01en5063
With more than 25 years of experience, we have created a unique laparoscopic Roux-en-Y gastric bypass technique with hand-sewn gastrojejunostomy and several additional steps which offer our patients a safe and reliable procedure. We routinely use 5 bladeless 12mm trocars. The procedure begins with the creation of a 15-20mL gastric pouch with a tilted orientation for the first stapling (not horizontal), and staple lines are oversewn for both gastric pouch and gastric remnant. A blue dye test is always performed at this stage. The second stage of the procedure includes the creation of a 75cm biliopancreatic limb with division of the mesentery and creation of a mechanical jejunojejunostomy with a 100cm alimentary limb, and hand-sewn closure of the enterotomy. Anti-torsion stitches are mandatory at this point. Closure of mesenteric defects (intermesenteric space and Petersen's space) is accomplished with non-absorbable sutures performed in a routine manner. The third and final stage of the procedure involves the creation of the hand-sewn gastrojejunostomy with an interposed limb and 4 layers of absorbable sutures over a 28-30 French bougie. Closure of all trocar defects is performed in every patient.