Laparoscopic Roux-en-Y gastric bypass - Evaluation of three different techniques

Background: The Roux-en-Y gastric bypass (RYGBP) is one of the ideal operations for morbid obesity. The minimal invasive laparoscopic technique has been performed to shorten the operative time and to reduce the complications of the open surgery. Methods: From Jan 1999 through Jan 2001, laparoscopic RYGBP (LRYGBP) was attempted in 90 patients. Median age was 30, with median preoperative BMI 47. The preoperative nutritional habits and comorbidities were recorded. LRYGBP was done by three different techniques in three equal groups. In the first group, the gastrojejunostomy was constructed by passing the EEA anvil transorally, using a pull-wire technique. In the second group, the gastrojejunostomy was fashioned with a totally handsewn technique. In the third group, the gastrojejunostomy was performed with an endo-cutter cartridge and the anastomotic incision was closed with an endo TA30 stapler. Results: The results were nearly identical in the three groups. Average excess weight loss at 1 year was 70%. The mean operating time was 120 min in the first group, 100 min in the second group and 75 min in the third group. Esophageal injury was the most common problem in the first group. Incidence of gastrojejunostomy stenosis was higher in the second group (36.6%). Incidence of internal herniation was higher in the second (17%) and first (13.6%) groups than in the third group (3.3%). Conclusion: Whichever technique is used to construct the gastrojejunostomy, LRYGBP is a safe, effective and technically feasible operation for morbidly obese patients. We recommend the technique of constructing the gastrojejunostomy with an endocutter cartridge and closing the anastomotic incision with an endo TA stapler, as it saved time and reduced the incidence of the essential complications in gastric bypass surgery.