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Laparoscopic Gastric Bypass Roux Y Limb

 

 

The laparoscopic gastric bypass with Roux en Y Reconstruction combines a restrictive and a malabsorptive procedure. Simply, the sustained weight loss is accomplished by creating a small stomach with a (non-banded) calibrated, small outflow and a 100 cm portion of the small bowel with diminished absorption (see diagram). It remains the "Gold Standard" in bariatric surgery.

 

It is accomplished as follows (technical breakdown):

 

  • The Laparoscopy: After the patient is put to sleep and positioned properly on the operating table, CO2 gas is insufflated in the intra-abdominal cavity (abdomen). Six small incisions are made and trocars (special access devices) are placed. The intra-abdominal cavity is visualized and checked with a special camera (laparoscope).

 

  • The Creation of the Roux en Y Limb: The first portion of the small bowel is found and checked. It is also cut with a cutting-stapling device (ENDOGIA). A limb or portion of jejunum is measured (100 to 145 cm) and the small bowel is re-attached together using the same stapling device (the entero-enterostomy). The Roux en Y limb is moved upward toward the new gastric pouch. 

  • The Creation of the Small Gastric Pouch: The stomach is checked and mobilized (some of its attachments are cut). A special tube (inserted through the nose into the stomach) is used to size and calibrate the capacity of the gastric pouch to be created. The stomach is cut and stapled (simultaneously with a surgical stapling device or ENDOGIA) to create a small (20 ml) gastric pouch. The rest of the stomach is left intact.

  • Attaching the Roux Limb to the Gastric Pouch: Using a special technique and surgical stapling device, the Roux en Y limb is attached to the new gastric pouch (the gastro-enterostomy). This is the most delicate portion of the procedure.

     

  • Checking the Integrity of the Procedure: The attachment of the stomach to the Roux en Y limb is checked by insufflating high pressure air in the small gastric pouch and checking for leaks.

 

  •  Placing the Drain: A drain is left next to the gastro-enterostomy and will exit through the abdomen of the patient.

 

  • Associated Procedures and Techniques: If your surgeon has decided to perform another surgical procedure at the same time such as a cholecystectomy (removal of the gallbladder), it will performed at the same time.

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