Are there preoperative parameters that are predictive of the technical difficulties of the procedure? What is the ideal case for a beginner in gastric bypass surgery?

In this original live educational 2-hour video, Dr. Kelvin Higa describes his personal technique of laparoscopic Roux-en-Y gastric bypass after removal of an adjustable gastric band, highlighting the importance of proper placement of working ports, careful dissection of the esophagogastric junction, objective measurement of the total length of the small bowel, and hand-sewing of the gastrojejunal anastomosis.

In this live educational video, Dr. Michel Vix demonstrates a stepwise laparoscopic Roux-en-Y gastric bypass procedure in a 39-year-old female patient with a BMI of 38. After stapled creation of the gastric pouch and splitting of the greater omentum, a stapled (antecolic/antegastric) gastrojejunostomy and a jejunojejunostomy are performed. Both mesentery hernia ports are closed.

In this live educational video, Dr. Vieira d'Almeida outlines surgical pitfalls when performing a 5-port Roux-en-Y gastric bypass (RYGB) using the da Vinci Xi™ robotic surgical system (Intuitive Surgical). During the video, a comparison is made with other robotic platforms (e.g. da Vinci Si™ system) regarding trocar placement, robotic docking, dexterity, instruments quality, and the introduction of fluorescence systems. Technical steps are provided to create a RYGB with a 100cm alimentary limb and a 150cm biliary limb, transection of the greater omentum, Petersen’s defect and mesenteric defect closure, which are performed routinely.

In this live educational video, Dr. Almino Cardoso Ramos shows the case of a morbidly obese 42-year-old woman with a BMI of 41. In the preoperative work-up, the patient lost 4kg. Imaging studies showed normal anatomy and did not evidence any hiatal hernia or GERD. Manometry did not show any motility disorders.
During the procedure, surgical pitfalls are highlighted and discussed in order to create a standardized Roux-en-Y gastric bypass (RYGB) with a biliopancreatic limb of 150cm and an alimentary limb of 100cm. Anatomical landmarks for gastric pouch creation are demonstrated. Emphasis is put on the adequate length measurement for both the biliopancreatic and alimentary limbs in order to ensure weight loss. The author also stresses the necessity to use appropriate staplers along with the ways to prevent stapler-related complications. He outlines his preference for specific suture material to close the enterotomy, and provides tips and tricks for the closure of the mesenteric defect and of Petersen’s space.

In this key lecture, Dr. Michel Sutter outlines long-term complications after Roux-en-Y gastric bypass (RYGB) and provides some relevant examples.