Circular Stapler Technique for Gastroenterostomy

  • Alan Wittgrove
  • Tomasz Rogula


In 1993, the first author of this chapter developed the laparoscopic gastric bypass, and in 1994 the technique was first reported with results (1). In this operation, the gastroenterostomy was created with a 21-mm circular stapling device. The technique of stapler anvil placement involves pulling the anvil down from the mouth to the stomach pouch with a wire being placed percutaneously. This technique was derived from the method used in the percutaneous endoscopic gastrostomy tube placement. The key step was the development of the Endopath Stealth endoscopic/conventional circular stapler, 21 mm, by Ethicon Endosurgery (Cincinnati, OH) (2). We used the 21-mm stapler because it creates a uniform and reproducible 12-mm anastomosis and that was the size of the gastroenterostomy we used for over 6 years as we performed the operation via an open laparotomy. This also preserved the minimal gastric pouch, which is essential to long-term weight control (3). We had tried several methods of anvil placement as we were developing the concept of the laparoscopic gastric bypass in nonhuman models.


Gastric Bypass Excess Weight Loss Staple Line Gastric Pouch Roux Limb 
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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Alan Wittgrove
    • 1
  • Tomasz Rogula
    • 2
  1. 1.Wittgrove Bariatric CenterScripps Memorial HospitalLa JollaUSA
  2. 2.Bariatric and Metabolic Institute, Department of General SurgeryCleveland ClinicClevelandUSA

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