Tips and tricks for jejuno-jejunostomy in laparoscopic gastric bypass

Laparoscopic antireflux surgery is currently a common procedure performed in a variety of different hospital categories. In this lecture, Dr. Bernard Dallemagne presents the possible complications that surgeons may encounter when performing this procedure detailing therapeutic modalities.

The video entitled “Laparoscopic Roux-en-Y gastric bypass after gastric band removal with severe small bowel adhesions”, authored by M Vix and J Marescaux is analyzed by Shashank Shah, MBBS, MS, FAIS, FMAS (Hon.), FICS (Laparo-Obeso Centre, Pune, Maharashtra, India), sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

The video "Laparoscopic Roux-en-Y gastric bypass after vertical banded gastroplasty" authored by M. Vix, F. Costantino and J. Marescaux is analysed by Dr. Kelvin Dwight Higa, MD, FACS, FASMBS, sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

Gastric bypass for morbid obesity is largely performed worldwide and currently represents the gold standard of treatment. In this key lecture, Dr. Michel Suter presents the different possible complications after laparoscopic Roux-en-Y gastric bypass and their management.

This video demonstrates the use of a EEA circular stapler in performing the gastro-jejunal anastomosis during the gastric bypass surgery. The surgeon demonstrates the preparation of the anvil, the transoral intubation, and introduction of the shaft. This video is intended to provide basic instruction as to the use of this specific technique.

Peptic ulcer disease is the major cause of benign gastro-duodenal obstruction or gastric outlet obstruction (GOO) in the adult population. Patients often present with abdominal pain and distension, vomiting, dehydration, and weight loss. Previous studies have demonstrated that the incidence of GOO varies from 5% to 10% of all hospital admissions for ulcer-related complications.
Today surgeons are performing fewer elective ulcer surgeries, as H2 receptor blockers and the eradication of Helicobacter pylori represent a major step in the treatment of this disease. Nevertheless, patients with complications and those resistant to medical therapy can be offered surgical options. When surgery is required, a laparoscopic approach is possible with its well-known advantages.
Surgical procedures include highly selective vagotomy with some form of pyloroplasty, truncal vagotomy and antrectomy, and truncal vagotomy with gastroenterostomy. Proponents of highly selective vagotomy advocate an acceptably low recurrence rate (0 to 5% at follow-up of 24 to 90 months) and a relative paucity of post-gastrectomy sequelae. Those recommending vagotomy and antrectomy stress the superiority of the acid-reducing procedure, the virtual absence of recurrent ulceration, and the rarity of postoperative symptoms other than post-vagotomy diarrhea, which is usually a self-limited process. Finally, truncal vagotomy with gastroenterostomy avoids what can be a treacherous duodenal stump, but can result in higher ulcer recurrence rates.
We present the case of a young male patient not compliant to medical treatment who was referred to us for gastric outlet obstruction. The selected approach consisted in a laparoscopic Billroth II antrectomy and vagotomy using four ports.