Tips and tricks for jejuno-jejunostomy in laparoscopic gastric bypass

This is the case of a 75-year old female patient with a medical history of bilateral mastectomy due to cancer, which occurred 30 and 15 years before referral. She was treated using adjuvant chemotherapy (tamoxifen) and radiotherapy, and had a liver-related kidney donation. The patient was found asymptomatic when she underwent a control abdominal ultrasound, which showed a 6cm hepatic mass in liver segments V and VI. A hepatic MRI was performed and showed a single liver lesion (68mm in diameter) located in the right liver lobe, and a PET-CT-scan demonstrated an increased hypermetabolic activity of the lesion without other systemic tumor dissemination. A laparoscopic right hepatectomy was scheduled. A laparoscopic surgery was performed. Laparoscopic exploration revealed multiple bilateral lesions, and an intraoperative ultrasound demonstrated a lesion in liver segment IV. An ALPPS approach was considered.
There were no complications and the patient was discharged on the third postoperative day.

This video shows how to perform laparoscopic Roux-en-Y bypass in a standardised fashion. Every step is clearly shown and explained.

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.

A subgroup of patients who receive the LAP-BAND fail to lose enough weight or present severe complications. Gastric bypass, which has both restrictive and malabsorptive components, is a good second-line choice for patients who did not do well with the band.

The video "Laparoscopic total gastrectomy for pT2 N0 M0 adenocarcinoma of the lesser curvature of the stomach" authored by B. Dallemagne, F. Costantino and J. Marescaux is analysed by Dr. Han-Kwang Yang, MD, sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

Since the first operation performed in 2005, single incision laparoscopic surgery has been used around the world to perform many procedures. Problems still remain for exposure. This video shows a single incision laparoscopic Nissen fundoplication with new curved and reusable instruments.

This video demonstrates a routine laparoscopic Nissen fundoplication with division of short gastric vessels, crural repair and mobilization of the esophagus through the hiatus to achieve adequate intra-abdominal length.

This is a video demonstrating laparoscopic total gastrectomy for adenocarcinoma. Mobilization of the greater omentum and stomach are presented in detail, together with vascular and lymph node dissection according to the Japanese gastric cancer classification. Finally, a stapled esophago-jejunostomy is performed for restoration of gastro-intestinal continuity. This is another case where Dr. Dallemagne, MD demonstrates how a complex resection can be undertaken laparoscopically using a stepwise approach.

Natural orifice specimen extraction (NOSE) is well described in colorectal surgery. In this video, Professor Huscher presents a case of NOSE procedure with transoral extraction for gastric cancer.

Roux-en-Y gastric bypass (RYGB) has become a common procedure for the management of morbid obesity. However, learning to perform such a procedure may be difficult as it is made up of very technical operative steps in complex cases of overweight patients with a great amount of adipose tissue. In order to prevent complications, an operative strategy should be adopted, allowing for an easy and rapid acquisition of the technique. Each step is perfectly mastered and outlined.
This video demonstrates a laparoscopic Roux-en-Y gastric bypass performed live, showing all the preoperative and operative patient settings. The surgical technique is thoroughly explained.