Laparoscopic Gastric Bypass: Technique and Outcomes

  • Kelvin D. HigaEmail author


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.


Obstructive Sleep Apnea Gastric Bypass Hiatal Hernia Gastric Pouch Roux Limb 
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.


  1. 1.
    Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg. 1994;4:4353–7.CrossRefGoogle Scholar
  2. 2.
    Mason EE, Ito C. Gastric bypass in obesity. Surg Clin North Am. 1967;47:1345–51.PubMedGoogle Scholar
  3. 3.
    Evans S, Pamuklar Z, Rosko J, Mahaney P, Jiang N, Park C, Torquati A. Gastric bypass surgery restores meal stimulation of the anorexigenic gut hormones glucagon-like peptide-1 and peptide YY independently of caloric restriction. Surg Endosc. 2012;26(4):1086–94.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Hatoum IJ, Greenawalt DM, Cotsapas C, Reitman ML, Daly MJ, Kaplan LM. Heritability of the weight loss response to gastric bypass surgery. J Clin Endocrinol Metab. 2011;96(10):1630–3.CrossRefGoogle Scholar
  5. 5.
    De la Torre RA, Scott JS. Laparoscopic Roux-en-Y gastric bypass: a totally intra-abdominal approach—technique and preliminary report. Obes Surg. 1999;9:101–6.CrossRefGoogle Scholar
  6. 6.
    Williams MD, Champion JK. Linear technique of laparoscopic Roux-en-Y gastric bypass. Surg Technol Int. 2004;13:101–5.PubMedGoogle Scholar
  7. 7.
    Iannelli A, Facchiano E, Gugenheim J. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2006;16:1265–71.PubMedCrossRefGoogle Scholar
  8. 8.
    Jones K. Experience with the Roux-en-Y gastric bypass, and commentary on current trends. Obes Surg. 2000;10:183–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Pories W, Swanson M, MacDonald K. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Sugerman HJ, Wolfe LG, Sica DA, Clore JN. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg. 2003;237:751–8.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Christou NV, Look D, Maclean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244:734–40.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Higa KD, Ho T, Tercero F, Yunus T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7:516–25.PubMedCrossRefGoogle Scholar
  13. 13.
    Himpens J, Verbrugghe A, Cadiėre G, Everaerts W, Greve J. Long-term results of laparoscopic Roux-en-Y gastric bypass: evaluation after 9 years. Obes Surg. 2012;22:1586–93.PubMedCrossRefGoogle Scholar
  14. 14.
    Adams T, Davidson L, Litwin S, Kolotkin RL, LaMonte MJ, Pendleton RC, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;11:1122–31.CrossRefGoogle Scholar
  15. 15.
    Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.PubMedCrossRefGoogle Scholar
  16. 16.
    Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, Swedish Obese Subjects Study, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.PubMedCrossRefGoogle Scholar
  17. 17.
    Suter M, Donadini A, Romy S, Demartines N, Giusti V. Laparoscopic Roux-en-Y gastric bypass: significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann Surg. 2011;254(2):267–73.PubMedCrossRefGoogle Scholar
  18. 18.
    Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;4:621–32.CrossRefGoogle Scholar
  19. 19.
    Podnos YD, Jimenez JC, Wilson SE, Stevens CM, Nguyen NT. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg. 2003;138(9):957–61.PubMedCrossRefGoogle Scholar
  20. 20.
    King WC, Chen JY, Mitchell JE, Kalarchian MA, Steffen KJ, Engel SG, et al. Prevalence of alcohol use disorders before and after bariatric surgery. JAMA. 2012;307(23):2516–25.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Surgery, Minimally Invasive and Bariatric SurgeryFresno Heart and Surgical Hospital, University of California San FranciscoFresnoUSA

Personalised recommendations