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Standardization of Technique in Roux-en-Y Gastric Bypass

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Bariatric Surgical Practice Guide

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Abstract

The Roux en Y Gastric Bypass (RYGB) is widely considered the gold standard in bariatric surgery; achieving superior weight-loss with acceptable complication rates [1]. It has generally been considered as a reference bariatric surgical procedure when comparing the outcomes of a new procedure. RYGB is also a metabolic procedure as it results in significant improvements of diabetes mellitus, hypertension, dyslipidemia and sleep apnea, along with a subsequent reduction in overall mortality. Though the technique is now well defined, controversies continue to exist at certain aspects of the configuration [2].

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References

  1. Kassir R, Breton C, Lointier P, Blanc P. Laparoscopic Roux-en-Y gastric bypass with hand-sewn gastrojejunostomy using an absorbable bidirectional monofilament barbed suture: review of the literature and illustrative case video. Surg Obes Relat Dis. 2014;10(3):560–1.

    Article  PubMed  Google Scholar 

  2. Roberts K, Duffy A, Kaufman J, Burrell M, Dziura J, Bell R. Size matters: gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21(8):1397–402.

    Article  CAS  PubMed  Google Scholar 

  3. Frantzides CT, Carlson MA, Shostrom VK, Roberts J, Stavropoulos G, Ayiomamitis G, et al. A survey of dumping symptomatology after gastric bypass with or without lesser omental transection. Obes Surg. 2011;21(2):186–93.

    Article  PubMed  Google Scholar 

  4. Higa K, Ho T, Tercero F, Yunus T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7(4):516–25.

    Article  PubMed  Google Scholar 

  5. Kassir R, Lointier P, Tiffet O, Breton C, Blanc P. Laparoscopic Roux-en-Y gastric bypass: creation of the neogastric pouch. Obes Surg. 2015;25(1):131–2.

    Article  PubMed  Google Scholar 

  6. Capella RF, Iannace VA, Capella JF. An analysis of gastric pouch anatomy in bariatric surgery. Obes Surg. 2008;18(7):782–90.

    Article  PubMed  Google Scholar 

  7. Bendewald FP, Choi JN, Blythe LS, Selzer DJ, Ditslear JH, Mattar SG. Comparison of hand-sewn, linear-stapled, and circular-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2011;21(11):1671–5.

    Article  PubMed  Google Scholar 

  8. Gonzalez R, Lin E, Venkatesh KR, Bowers SP, Smith CD. Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques. Arch Surg. 2003;138(2):181–4.

    Article  PubMed  Google Scholar 

  9. Abdel-Galil E, Sabry AA. Laparoscopic Roux-en-Y gastric bypass – evaluation of three different techniques. Obes Surg. 2002;12(5):639–42.

    Article  PubMed  Google Scholar 

  10. Madan AK, Harper JL, Tichansky DS. Techniques of laparoscopic gastric bypass: on-line survey of American Society for Bariatric Surgery practicing surgeons. Surg Obes Relat Dis. 2008;4(2):166–72; discussion 172–3.

    Article  PubMed  Google Scholar 

  11. Rondan A, Nijhawan S, Majid S, Martinez T, Wittgrove AC. Low anastomotic stricture rate after Roux-en-Y gastric bypass using a 21-mm circular stapling device. Obes Surg. 2012;22(9):1491–5.

    Article  CAS  PubMed  Google Scholar 

  12. Leyba JL, Llopis SN, Isaac J, Aulestia SN, Bravo C, Obregon F. Laparoscopic gastric bypass for morbid obesity-a randomized controlled trial comparing two gastrojejunal anastomosis techniques. JSLS. 2008;12(4):385–8.

    PubMed  PubMed Central  Google Scholar 

  13. Nguyen NT, Stevens CM, Wolfe BM. Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass. J Gastrointest Surg. 2003;7(8):997–1003; discussion 1003.

    Article  PubMed  Google Scholar 

  14. Alasfar F, Sabnis AA, Liu RC, Chand B. Stricture rate after laparoscopic Roux-en-Y gastric bypass with a 21-mm circular stapler: the Cleveland clinic experience. Med Princ Pract. 2009;18(5):364–7.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gould JC, Garren M, Boll V, Starling J. The impact of circular stapler diameter on the incidence of gastrojejunostomy stenosis and weight loss following laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2006;20(7):1017–20.

    Article  PubMed  Google Scholar 

  16. Dolce CJ, Dunnican WJ, Kushnir L, Bendana E, Ata A, Singh TP. Gastrojejunal strictures after Roux-en-Y gastric bypass with a 21-MM circular stapler. JSLS. 2009;13(3):306–11.

    PubMed  PubMed Central  Google Scholar 

  17. Blackstone RP, Rivera LA. Predicting stricture in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass: a logistic regression analysis. J Gastrointest Surg. 2007;11(4):403–9.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Da Costa M, Mata A, Espinós J, Vila V, Roca JM, Turró J, et al. Endoscopic dilation of gastrojejunal anastomotic strictures after laparoscopic gastric bypass. Predictors of initial failure. Obes Surg. 2011;21(1):36–41.

    Article  PubMed  Google Scholar 

  19. Ukleja A, Afonso BB, Pimentel R, Szomstein S, Rosenthal R. Outcome of endoscopic balloon dilation of strictures after laparoscopic gastric bypass. Surg Endosc. 2008;22(8):1746–50.

    Article  PubMed  Google Scholar 

  20. Ruiz-de-Adana JC, López-Herrero J, Hernández-Matías A, Colao-Garcia L, Muros-Bayo J-M, Bertomeu-Garcia A, et al. Laparoscopic hand-sewn gastrojejunal anastomoses. Obes Surg. 2008;18(9):1074–6.

    Article  PubMed  Google Scholar 

  21. Takata MC, Ciovica R, Cello JP, Posselt AM, Rogers SJ, Campos GM. Predictors, treatment, and outcomes of gastrojejunostomy stricture after gastric bypass for morbid obesity. Obes Surg. 2007;17(7):878–84.

    Article  PubMed  Google Scholar 

  22. Fisher BL, Atkinson JD, Cottam D. Incidence of gastroenterostomy stenosis in laparoscopic Roux-en-Y gastric bypass using 21- or 25-mm circular stapler: a randomized prospective blinded study. Surg Obes Relat Dis. 2007;3(2):176–9.

    Article  PubMed  Google Scholar 

  23. Cottam DR, Fisher B, Sridhar V, Atkinson J, Dallal R. The effect of stoma size on weight loss after laparoscopic gastric bypass surgery: results of a blinded randomized controlled trial. Obes Surg. 2009;19(1):13–7.

    Article  PubMed  Google Scholar 

  24. Giordano S, Tolonen P, Victorzon M. Comparision of linear versus circular stapling techniques in laparoscopic gastric bypass surgery – a pilot study. Scand J Surg. 2010;99(3):127–31.

    Article  CAS  PubMed  Google Scholar 

  25. Bohdjalian A, Langer FB, Kranner A, Shakeri-Leidenmühler S, Zacherl J, Prager G. Circular- vs. linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2010;20(4):440–6.

    Article  PubMed  Google Scholar 

  26. Penna M, Markar SR, Venkat-Raman V, Karthikesalingam A, Hashemi M. Linear-stapled versus circular-stapled laparoscopic gastrojejunal anastomosis in morbid obesity: meta-analysis. Surg Laparosc Endosc Percutan Tech. 2012;22(2):95–101.

    Article  PubMed  Google Scholar 

  27. Papadia F. Effect of standard versus extended Roux limb length on weight loss outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2004;18(11):1683.

    CAS  PubMed  Google Scholar 

  28. Brolin RE, Kenler HA, Gorman JH, Cody RP. Long-limb gastric bypass in the superobese. A prospective randomized study. Ann Surg. 1992;215(4):387–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Choban PS, Flancbaum L. The effect of Roux limb lengths on outcome after Roux-en-Y gastric bypass: a prospective. Randomized clinical trial. Obes Surg. 2002;12(4):540–5.

    Article  PubMed  Google Scholar 

  30. Inabnet WB, Quinn T, Gagner M, Urban M, Pomp A. Laparoscopic Roux-en-Y gastric bypass in patients with BMI <50: a prospective randomized trial comparing short and long limb lengths. Obes Surg. 2005;15(1):51–7.

    Article  PubMed  Google Scholar 

  31. 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(5):734–40.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Savassi-Rocha AL, Diniz MTC, Savassi-Rocha PR, Ferreira JT, Rodrigues de Almeida Sanches S, Diniz Mde FHS, et al. Influence of jejunoileal and common limb length on weight loss following Roux-en-Y gastric bypass. Obes Surg. 2008;18(11):1364–8.

    Article  PubMed  Google Scholar 

  33. Nelson WK, Fatima J, Houghton SG, Thompson GB, Kendrick ML, Mai JL, et al. The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: results in 257 patients. Surgery. 2006;140(4):517–22; discussion 522–3.

    Article  PubMed  Google Scholar 

  34. Brolin RE, Cody RP. Adding malabsorption for weight loss failure after gastric bypass. Surg Endosc. 2007;21(11):1924–6.

    Article  PubMed  Google Scholar 

  35. Garza E, Kuhn J, Arnold D, Nicholson W, Reddy S, McCarty T. Internal hernias after laparoscopic Roux-en-Y gastric bypass. Am J Surg. 2004;188(6):796–800.

    Article  PubMed  Google Scholar 

  36. Higa K, Boone K, Arteaga González I, López-Tomassetti Fernández E. Mesenteric closure in laparoscopic gastric bypass: surgical technique and literature review. Cir Esp. 2007;82(2):77–88.

    Article  PubMed  Google Scholar 

  37. Iannelli A, Facchiano E, Gugenheim J. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2006;16(10):1265–71.

    Article  PubMed  Google Scholar 

  38. Comeau E, Gagner M, Inabnet WB, Herron DM, Quinn TM, Pomp A. Symptomatic internal hernias after laparoscopic bariatric surgery. Surg Endosc. 2005;19(1):34–9.

    Article  CAS  PubMed  Google Scholar 

  39. Champion JK, Williams M. Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13(4):596–600.

    Article  PubMed  Google Scholar 

  40. Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003;13(3):350–4.

    Article  PubMed  Google Scholar 

  41. Miyashiro LA, Fuller WD, Ali MR. Favorable internal hernia rate achieved using retrocolic, retrogastric alimentary limb in laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010;6(2):158–62.

    Article  PubMed  Google Scholar 

  42. Carmody B, DeMaria EJ, Jamal M, Johnson J, Carbonell A, Kellum J, et al. Internal hernia after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2005;1(6):543–8.

    Article  PubMed  Google Scholar 

  43. Cho M, Carrodeguas L, Pinto D, Lascano C, Soto F, Whipple O, et al. Diagnosis and management of partial small bowel obstruction after laparoscopic antecolic antegastric Roux-en-Y gastric bypass for morbid obesity. J Am Coll Surg. 2006;202(2):262–8.

    Article  PubMed  Google Scholar 

  44. Linner JH. Gastric operations. In: Linner JH, editor. Surgery for morbid obesity. New York: Springer; 1984. p. 65–107.

    Chapter  Google Scholar 

  45. Fobi MAL, Lee H, Flemming AW. The surgical techniqueof the banded gastric bypass. J Obes Weight Regulation. 1989;8:99–102.

    Google Scholar 

  46. Bessler M, Daud A, Kim T, DiGiorgi M. Prospective randomized trial of banded versus nonbanded gastric bypass for the super obese: early results. Surg Obes Relat Dis. 2007;3(4):480–4; discussion 484–5.

    Article  PubMed  Google Scholar 

  47. Fobi M, 2004 ABS Consensus Conference. Banded gastric bypass: combining two principles. Surg Obes Relat Dis. 2005;1(3):304–9.

    Article  PubMed  Google Scholar 

  48. Heneghan HM, Annaberdyev S, Eldar S, Rogula T, Brethauer S, Schauer P. Banded Roux-en-Y gastric bypass for the treatment of morbid obesity. Surg Obes Relat Dis. 2014;10(2):210–6.

    Article  PubMed  Google Scholar 

  49. Awad W, Garay A, Martínez C. Ten years experience of banded gastric bypass: does it make a difference? Obes Surg. 2012;22(2):271–8.

    Article  PubMed  Google Scholar 

  50. Al-Mansour MR, Mundy R, Canoy JM, Dulaimy K, Kuhn JN, Romanelli J. Internal hernia after laparoscopic antecolic Roux-en-Y gastric bypass. Obes Surg. 2015;25(11):2106–11.

    Article  PubMed  Google Scholar 

  51. Quartararo G, Facchiano E, Scaringi S, Liscia G, Lucchese M. Upper gastrointestinal series after Roux-en-Y gastric bypass for morbid obesity: effectiveness in leakage detection. a systematic review of the literature. Obes Surg. 2014;24(7):1096–101.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Minimal Access, Bariatric and GI Surgery Fortis Hospital, New Delhi, India

    Randeep Wadhawan MS, FIAGES, FMAS, FAIS, FICS

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  1. Randeep Wadhawan MS, FIAGES, FMAS, FAIS, FICS
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Correspondence to Randeep Wadhawan MS, FIAGES, FMAS, FAIS, FICS .

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Editors and Affiliations

  1. Bariatric Division, Upper Gastrointestinal Surgery and Minimal Access Surgery Unit, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India

    Saravana Kumar

  2. Bariatric Division, Upper Gastrointestinal Surgery and Minimal Access Surgery Unit, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India

    Rachel Maria Gomes

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Wadhawan, R. (2017). Standardization of Technique in Roux-en-Y Gastric Bypass. In: Kumar, S., Gomes, R. (eds) Bariatric Surgical Practice Guide. Springer, Singapore. https://doi.org/10.1007/978-981-10-2705-5_10

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  • DOI: https://doi.org/10.1007/978-981-10-2705-5_10

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