This video focuses on the essentials to perform a Laparoscopic Roux-n-Y gastric bypass.
Patient, surgeons & trocars positioning:
The patient is placed in the supine position with open legs. A total of three surgeons are needed. The leading surgeon stands between the patient’s legs with one assistant on each side.
A total of six trocars are used. A 12 mm port in the supraumbilical position is used for the camera during the supramesocolic stage of the surgery. Three 12 mm ports are placed at the epigastrium and on each flank. These are used to separate the liver and as working channels for the leading surgeon.
A 5mm trocar is placed more laterally on the left flank. The assistant surgeon uses it to perform traction. The final 12mm port is placed at the umbilicus and is used during the inframesocolic stage of the surgery.
Main anatomical landmarks:
The landmarks for the creation of the pouch are the angle of His and the second short gastric vessel. The biliopancreatic limb measures between 30-40 cm from the Treitz angle and the alimentary limb should measure 150 cm.
The Petersen´s defect is the mesentery gap located between the alimentary limb and the transverse colon mesocolon. A mesentery gap also appears after the creation of the jejuno-jejunal anastomosis.
Change in the surgeon’s positioning and working ports:
To create this anastomosis and for closure of the mesenteric gaps, the leading surgeon and one assistant stand to the right of the patient and one assistant stands between the patient’s legs. The camera is placed at the 12mm trocar on the right flank.
We always create the pouch in the same way. It is about 3 cm long, and has a volume of 30 – 40mm. A circular mechanical anastomosis with a 25mm diameter ensures the creation of exactly the same anastomosis with a 4.9 cm2 area for all patients.
We think that this is an important technical aspect to achieve sustainable long-term results.
Next November 20th 2015 AIS Channel will broadcast its 8th Live congress: Laparoscopic Roux-n-Y Gastric Bypass (LRYGBP): More than just a little intestinal operation. It will be focused in the state-of-art of the LRYGBP and its implications in the resolution of an important medical issue such as the T2DM.