Hand-assisted laparoscopic Roux-en-Y gastric bypass: Aspects of surgical technique and early results

Background: The efficacy of Roux-en-y gastric bypass (RYGBP) for morbid obe sity is well documented. We investigated the role of the Hand-assisted lapa roscopic technique for performing RYGBP. Methods: In an open series, 13 patients (all female, median age 38, BMI 45 kg/m(2)) underwent Hand-assisted laparoscopic RYGBP. The HandPort was intro duced through an 8-cm right subcostal incision. The stomach was always comp letely transected. The Roux limb was made > 50 cm and brought to the proxim al gastric pouch (4 x 3 cm) behind the colon and the excluded stomach. A ci rcular stapler (no. 21) was used for the gastrojejunostomy, with the anvil introduced through a gastrotomy Results: The HandPort device could be successfully placed and allowed good working conditions in all patients. Median duration of surgery (including l earning-curve time) and postoperative hospital stay were 205 min and 5 days , respectively. The amount of morphine needed (PCA) during postoperative da y 1-3 were 45, 32 and 18 mg, respectively. One patient (8%) was converted t o full laparotomy for safe closure of a small perforation of the proximal g astric pouch caused by the anvil of the circular stapler. All patients made an uneventful recovery. Two patients needed endoscopic dilatation of a rel ative stricture at the gastrojejunostomy. Conclusion: We believe that Hand-assistance makes Lap-RYGBP faster and safe r without losing the essential benefits of total laparoscopy.