A Simple Technique for Jejunojejunal Revision in Laparoscopic Roux-en-Y Gastric Bypass

Background The lengths of the bypassed segments in the initial laparoscopic roux-en-Y gastric bypass (LRYGB) are usually a matter of the individual surgeon’s routine. The literature is inconclusive about the association between the Roux limbs’ length and weight-loss or malabsorption (Stefanidis et a...

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Bibliographic Details
Published in:Obesity surgery 2015-12, Vol.25 (12), p.2461-2461
Main Author: Spivak, Hadar
Format: Article
Language:English
Subjects:
Gastric Bypass - methods
Gastrointestinal surgery
Humans
Jejunum - surgery
Laparoscopy
Medicine
Medicine & Public Health
Obesity
Reoperation - methods
Surgery
Surgical techniques
Video Submission
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Summary:Background The lengths of the bypassed segments in the initial laparoscopic roux-en-Y gastric bypass (LRYGB) are usually a matter of the individual surgeon’s routine. The literature is inconclusive about the association between the Roux limbs’ length and weight-loss or malabsorption (Stefanidis et al. Obes Surg. 21(1):119–24, 2011 ); (Rawlins et al. Surg Obes Relat Dis. 7(1):45–9, 2011 ). However, jejunojejunal anastomosis (JJ) “redo” and Roux limb length revision could be considered for patients with a very short Roux limb and weight loss failure or for short common channel and malabsorption. Complications of JJ may also require revision. Methods In over 1000 LRYGBs since 2001, eight patients required JJ revision for failure to lose enough weight ( n  = 6), malabsorption ( n  = 1), and stricture ( n  = 1). Instead of completely taking down the JJ, a simple technique was evolved to keep the enteric limb continuity. In a following step, the biliopancreatic limbs have been transected from the JJ and reconnected proximal (for malabsorption) or distal (for weight loss failure). Results In this video, a step-by-step the laparoscopic technique for JJ revision and relocating the biliopancreatic limb is presented. Procedure takes 40–60 min to perform using four trocars and the hospital stay was 1–2 nights. No complications occurred during the procedures or postoperative period. Conclusions Laparoscopic revision of JJ is feasible and safe and should be part of surgeons’ options on the long-term management of patients post LRYGB.
ISSN:0960-8923
1708-0428
DOI:10.1007/s11695-015-1885-2