The laparoscopic gastric bypass was once considered to be one of the most challenging minimally invasive operations. It is now the most common foregut operation and, despite its complexity and learning curve, has been shown to be safer and more cost-effective than its open predecessor. The operation has evolved to include a variety of anastomotic techniques and trocar placements, giving individual surgeons the latitude to adopt or modify the procedure based on their own preference and experience.
This chapter will discuss the basic construct and operative techniques in use today; there is no one method that is the “gold standard.” Comparative studies are few, and those that exist only reinforce that there are subtleties to operative technique that defy observation. For example, gastrojejunal stricture rate may be influenced more by preservation of blood supply and operative technique rather than the diameter of the circular stapler. It would be naïve to expect every surgeon to achieve the same results, given the same basic technique; it is up to each individual to modify, adapt, and improve through his or her own experience.
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