Laparoscopic Roux-en-Y Gastric Bypass: Controversies

  • J. K. Champion
  • Sayeed Ikramuddin


The characterization of the Roux-en-y gastric bypass as the “gold standard” for bariatric surgery has been misleading because there is no standard technique employed by the majority of surgeons (1). The laparoscopic gastric bypass has followed in the footsteps of the open approach and varies widely in construction (2, 3, 4, 5, 6). Controversies exist over the ideal methods to maximize outcomes and minimize complications, which are the goals of every surgical procedure. This chapter explores several of the current controversies about the laparoscopic gastric bypass technique.


Bariatric Surgery Gastric Bypass Sleeve Gastrectomy Small Bowel Obstruction Staple Line 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Talieh J, Kirgan D, Fisher BL. Gastric bypass for morbid obesity: a standard surgical technique by consensus. Obes Surg 1997;7:198–202.CrossRefPubMedGoogle Scholar
  2. 2.
    Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y—500 patients: technique and results, with 3–60 month follow-up. Obes Surg 2000;10:233–239.CrossRefPubMedGoogle Scholar
  3. 3.
    Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000;232:515–529.PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    DeMaria EJ, Sugerman HJ, Kellum JM, et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 2002;235:640–647.CrossRefGoogle Scholar
  5. 5.
    Higa KD, Boone KB, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1040 patients—what have we learned? Obes Surg 2000;10:509–513.CrossRefPubMedGoogle Scholar
  6. 6.
    Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 2001;234:279–291.PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    MacLean LD, Rhode BM, Nohr CW. Long-or short-limb gastric bypass? J Gastrointest Surg 2001;5:525–530.CrossRefPubMedGoogle Scholar
  8. 8.
    Halverson JD, Koehler RE. Gastric bypass: analysis of weight loss and factors determining success. Surgery 1981; 90(3):446–455.PubMedGoogle Scholar
  9. 9.
    Fobi MAL, Lee H, Igwe D, et al. Revision of failed gastric bypass to distal Roux-en-Y gastric bypass: a review of 65 cases. Obes Surg 2001;11:190–195.CrossRefPubMedGoogle Scholar
  10. 10.
    Bessler MD, Daud A, Olivero-Rivera D, DiGiorgi M. Prospective randomized double blinded trial of banded versus standard gastric bypass in patients with malignant obesity. Presented at the 21st annual meeting of the American Society for Bariatric Surgery, 2004.Google Scholar
  11. 11.
    Fobi MAL, Lee H, Igwe D, Malgorzatam S, Tambi J. Prospective Comparison of Stapled versus transected Silastic ring gastric bypass: 6-year follow-up. Obes Surg 2001;11:18–24.CrossRefPubMedGoogle Scholar
  12. 12.
    Sapala JA, Wood MH, Sapala MA, Schuhknecht MP, Flake TM. The Micropouch gastric bypass: technical considerations in primary and revisionary operations. Obes Surg 2001; 11:3–17.CrossRefPubMedGoogle Scholar
  13. 13.
    Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg 1998;8(3):267–282.CrossRefPubMedGoogle Scholar
  14. 14.
    Torres CJ. Why I prefer gastric bypass distal Roux-en-Y gastroileostomy. Obes Surg 1991;1:189–194.CrossRefPubMedGoogle Scholar
  15. 15.
    Brolin RE, Kenler HA, Gorman JH, et al. Long limb gastric bypass in the superobese, a prospective randomized. Ann Surg 1992;215:387–395.PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Brolin RE, La Marca LB, Kenler HA, et al. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg 2002;6:195–205.CrossRefPubMedGoogle Scholar
  17. 17.
    Choban P, Flancbaum L. The effect of Roux limb length on outcome after Roux-en-Y gastric bypass: a randomized prospective clinical trial. Obes Surg 2002;12:540–545.CrossRefPubMedGoogle Scholar
  18. 18.
    Livingston EH, Huerta S, Arthur D, Lee S, DeShields S, Heber D. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg 2002;236:576–582.PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Marceau S, Biron S, Lagace M, et al. Biliopancreatic diversion, with distal gastrectomy, 250 cm and 50 cm limbs: longterm results. Obes Surg 1995;5:302–307.CrossRefPubMedGoogle Scholar
  20. 20.
    Johnston D, Dachtler J, Sue-Ling HM, King RF, Martin G. The Magenstrase and Mill operation for morbid obesity [see comment]. Obes Surg2003;13(1):10–16.CrossRefPubMedGoogle Scholar
  21. 21.
    Lee C, Cirangle PT, Feng JJ, Jossart GH. Comparison of BMI matched patients undergoing isolated laparoscopic sleeve gastrectomy versus the laparoscopic Roux-en-Y gastric bypass. Presented at the 21st annual meeting of the American Society for Bariatric Surgery, 2004.Google Scholar
  22. 22.
    Champion JK, Williams M. Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2003;13:596–600.CrossRefPubMedGoogle Scholar
  23. 23.
    Felix E, Brown JE. Preventing small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2002;12:197.Google Scholar
  24. 24.
    Schauer PR, Ikramuddin S, Hamad G, et al. Ante-colic versus retro-colic laparoscopic Roux-en-Y gastric bypass. Surg Endosc 2003;17:S188.CrossRefGoogle Scholar
  25. 25.
    Schweitzer MA, DeMaria EJ, Broderick TJ, et al. Laparoscopic closure of mesenteric defects after Roux-en-Y gastric bypass. J Laproendosc Adv Surg Tech 2000;10:173–175.CrossRefGoogle Scholar
  26. 26.
    Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg 2003;13:350–354.CrossRefPubMedGoogle Scholar
  27. 27.
    Gonzalez R, Lin E, Venkatesh KR, et al. Gastrojejunostomy during laparoscopic gastric bypass. Arch Surg 2003; 138:181–184.CrossRefPubMedGoogle Scholar
  28. 28.
    Liu CD, Glantz GJ, Livingston EH. Fibrin glue as a sealant for high risk anastomosis in surgery for morbid obesity. Obes Surg 2003;13:45–49.CrossRefPubMedGoogle Scholar
  29. 29.
    Sapala JA, Wood MH. Prevention of anastomotic leaks using a vapor heated fibrin sealant: an analysis of 738 gastric bypass patients. Obes Surg 2003;13:211–212.CrossRefGoogle Scholar
  30. 30.
    Arnold W, Shikora SA. Comparing seam burst pressure: buttressed versus non-buttressed linear cutting staple devices in a porcine model. Obes Surg 2002;12:208.Google Scholar
  31. 31.
    Shikora SA, Kim J, Tarnoff ME. Reinforcing gastric staple lines with bovine pericardial strips may decrease the likelihood of gastric leak after laparoscopic roux-en-y gastric bypass. Obes Surg 2003;13:37–44.CrossRefPubMedGoogle Scholar
  32. 32.
    Champion JK, Hunt T, Delisle N. Role of routine intraoperative endoscopy in laparoscopic bariatric surgery. Surg Endosc 2002;16:1663–1665.CrossRefPubMedGoogle Scholar
  33. 33.
    Ramanathan R, Ikramuddin S, Gourash W, et al. The value of intra-operative endoscopy during laparoscopic roux-eny gastric bypass. Surg Endosc 2000;14:S212.Google Scholar
  34. 34.
    Hamilton EC, Sims TL, Hamilton TT, et al. Clinical predictors of leak after laparoscopic roux-en-y gastric bypass for morbid obesity. Surg Endosc 2003;17:679–684.CrossRefPubMedGoogle Scholar
  35. 35.
    Hawthorne A, Kuhn J, McCarty T. The role of routine upper GI series following Roux-en-Y gastric bypass. Obes Surg 2003;13:222–223.Google Scholar
  36. 36.
    Singh R, Fisher BL. Sensitivity and specificity of post-op GI series following gastric bypass for morbid obesity. Obes Surg 2002;12:195–196.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • J. K. Champion
    • 1
    • 2
  • Sayeed Ikramuddin
    • 3
  1. 1.Department of SurgeryMercer University School of MedicineUSA
  2. 2.Department of SurgeryEmoryDunwoody Medical CenterAtlantaUSA
  3. 3.Center for Minimally Invasive Surgery, Department of SurgeryUniversity of MinnesotaMinneapolisUSA

Personalised recommendations