Ja. Teixeira et al., An alternative technique for creating the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass: Experience with 28 consecutive patients, OBES SURG, 10(3), 2000, pp. 240-244
Background: This study illustrates our experience in laparoscopic Roux-en-Y
gastric bypass (LRYGBP) using a new technique for creating the gastrojejun
ostomy.
Methods: Between April and November 1999, 28 patients underwent LRYGBP. In
the first 10 patients the transoral route with endoscopic guidance was util
ized for placement of the anvil in the gastric pouch. A new totally intra-p
eritoneal approach was utilized in the next 18 patients, avoiding the trans
-oral route.
Results: There were 23 women and 5 men with an average age of 36 years (ran
ge 24-51). The mean BMI was 47, with range 41-64. Of the patients, 82% had
one or more associated co-morbid conditions (hypertension, diabetes, sleep
apnea, arthritis). Average operative time in the first 10 patients using th
e trans-oral route with endoscopic guidance was 340 minutes (range 240-390
min). The next 18 patients underwent totally intra-peritoneal anvil placeme
nt with a 240-minute average operating time (range 150-310 min). There were
no open conversions or mortalities, There were 4 complications, including
2 wound infections, one urinary tract infection, and one intra-abdominal ab
scess. The two wound infections occurred in the first 10 patients that unde
rwent trans-oral introduction of the anvil.
Conclusions: LRYGBP was a safe and feasible operation. We believe that our
technique is easily reproducible, avoiding the trans-oral route for introdu
cing the anvil. This technique may also decrease operative time and possibl
y the incidence of wound infections, although we are still in the learning
curve and final conclusions cannot be made.