Laparoscopic gastric bypass in a patient with a BMI of 51
Epublication WebSurg.com, Jun 2007;07(06). URL: http://websurg.com/doi/vd01en2068
This video demonstrates the bariatric procedure of Roux-en-Y gastric bypass, with the Roux limb in the ante-colic position. The jejunojejunostomy is performed with a linear stapler, while the gastrojejunostomy is carried out with a circular stapler; the anvil having been passed down from the mouth into the stomach, attached to the end of a nasogastric tube. This video is suitable for bariatric surgeons. The authors identify the duodenojejunal flexure (ligament of Treitz). They measure a biliary loop of 75cm, shelving that to the left and temporarily attaching it to the stomach before marking it. They then measure a 150cm alimentary limb and place it in the right side of the abdomen, and attach it with a suture to the end of the biliary loop. They create a minimal opening in the two loops with a cautery hook to allow passage of the linear stapler, using 2.5mm staples. They close the opening through which the linear stapler is introduced with an absorbable 2/0 braided running suture. The procedure continues with the closure of the mesenteric defect.