Skip to main content
SpringerLink
Log in

“What Really Matters When Performing a Laparoscopic Roux-en Y Gastric Bypass?” Literature-Based Key Steps Towards Success and Standardization of the Procedure

  • Review
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Lack of standardization in the Roux-en-Y gastric bypass (RY-GBP) is quite well established. We all learned the basics of the technique, but a lot of differences do exist in performing each step of the procedure. Based on scientific evidences, coming from an extensive and meticulous review of the literature of the last 20 years, we thus address the different technical steps of the procedure and their importance to try and propose a standardization of RYGBP. A lot of possibilities exist at each and every step of a RYGBP. They influence the postoperative complications, the end weight loss (EWL), weight regain, and resolution of obesity bounded comorbidities. Furthermore, lack of standardization leads to problems regarding comparison of scientific data in the related literature.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Wittgrove AC, Clarke GW. Laparoscopic gastric bypass: a five-year prospective study of 500 patients followed from 3 to 60 months. Obes Surg. 1999;9:123–43.

    Article  Google Scholar 

  2. Müller MK, Guber J, Wildi S, et al. Three-year follow-up study of retrocolic versus antecolic laparoscopic roux-en-y gastric bypass. Obes Surg. 2007;17:889–93. https://doi.org/10.1007/s11695-007-9165-4.

    Article  PubMed  Google Scholar 

  3. Ahmed AR, Rickards G, Husain S, et al. Trends in internal hernia incidence after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17:1563–6. https://doi.org/10.1007/s11695-007-9260-6.

    Article  PubMed  Google Scholar 

  4. Ayman B, Harakeh Al, Kara J, et al. Bowel obstruction rates in antecolic/antegastric versus retrocolic/retrogastric Roux limb gastric bypass: a meta-analysis. SOARD. 2016;12–11:194–8.

    Google Scholar 

  5. Edholm D, et al. Importance of pouch size in laparoscopic Roux-en-Y gastric bypass: a cohort study of 14,168 patients. Surg Endosc. 2016;30(5):2011–5. https://doi.org/10.1007/s00464-015-4432-2.

    Article  PubMed  Google Scholar 

  6. Riccioppo D, Santo MA, Rocha M, et al. Small-volume, fast-emptying gastric pouch leads to better long-term weight loss and food tolerance after Roux-en-Y gastric bypass. Obes Surg. 2018;28(3):693–701. https://doi.org/10.1007/s11695-017-2922-0.

    Article  PubMed  Google Scholar 

  7. Mahawar K, Sharples A, Graham Y. A systematic review of the effect of gastric pouch and/or gastrojejunostomy (stoma) size on weight loss outcomes with Roux-en-Y gastric bypass. Surg Endosc. 2020;34(3):1048–60.

    Article  Google Scholar 

  8. Heneghan HM, et al. Influence of pouch and stoma size on weight loss after gastric bypass. Surg Obes Relat Dis. 2012;8(4):408–15.

    Article  Google Scholar 

  9. Ramos AC, Marchesini JC, de Souza Bastos E.L., et al. The role of gastrojejunostomy size on gastric bypass weight loss. Obes Surg. 2017;27:2317–23. https://doi.org/10.1007/s11695-017-2686-6.

    Article  PubMed  Google Scholar 

  10. Jiang HP, Lin LL, Jiang X, Qiao HQ. Meta-analysis of hand-sewn versus mechanical gastro-jejunal anastomosis during laparoscopic Roux-en-Y gastric bypass for morbid obesity. Int J Surg. 2016;32:150–7.

    Article  Google Scholar 

  11. Giordano S, Salminen P, Biancari F, Victorzon M. Linear stapler technique may be safer than circular in gastrojejunal anastomosis for laparoscopic Roux-en-Y gastric bypass: a meta-analysis of comparative studies. Obes Surg. 2011;21(12):1958–64.

    Article  Google Scholar 

  12. Vasquez JC, Overby DW, Farrell TM. Fewer gastrojejunostomy strictures and marginal ulcers with absorbable suture. Surg Endosc. 2009;23(9):2011–5.

    Article  Google Scholar 

  13. Sacks BC, Mattar SG, Qureshi FG, et al. Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006;2(1):11–6.

    Article  Google Scholar 

  14. Shikora SA, Mahoney CB. Clinical benefit of gastric staple line reinforcement (slr) in gastrointestinal surgery: a meta-analysis. Obes Surg. 2015;25(7):1133–41. https://doi.org/10.1007/s11695-015-1703-x.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Tartamella F, Petracca G, Romboli AF. Laparoscopic gastric bypass with remnant gastrectomy in a super-super obese patient with gastric metaplasia: a surgical hazard? Acta Biomed. 2017;88(4):491–5.

    PubMed Central  Google Scholar 

  16. Sodji M, Sebag FJ, Catheline JM. Laparoscopic gastric bypass with subtotal gastrectomy for a super-obese patient with Biermer anemia. Obes Surg. 2007;17(8):1132–5.

    Article  Google Scholar 

  17. Voellinger D, Inabnet W. Laparoscopic Roux-en-Y gastric bypass with remnant gastrectomy for focal intestinal metaplasia of the gastric antrum. Obes Surg. 2002;12(5):695–8.

    Article  Google Scholar 

  18. Fobi MA, Lee H, Felahy B, Che K, Ako P, Fobi N. Choosing an operation for weight control, and the transected banded gastric bypass. Obes Surg. 2005;15(1):114–21. https://doi.org/10.1381/0960892052993404.

    Article  PubMed  Google Scholar 

  19. Buchwald H, Buchwald JN, McGlennon TW. Systematic review and meta-analysis of medium-term outcomes after banded Roux-en-Y gastric bypass. Obes Surg. 2014;24(9):1536–51. https://doi.org/10.1007/s11695-014-1311-1.

    Article  CAS  PubMed  Google Scholar 

  20. Lemmens L. Banded gastric bypass: better long-term results? A cohort study with minimum 5-year follow-up. Obes Surg. 2017;27(4):864–72. https://doi.org/10.1007/s11695-016-2397-4.

    Article  PubMed  Google Scholar 

  21. Dogan K, Homan J, Aarts EO, et al. A short or a long Roux limb in gastric bypass surgery: does it matter? Surg Endosc. 2017;31(4):1882–90.

    Article  Google Scholar 

  22. Homan J, Boerboom A, Aarts E, et al. A longer biliopancreatic limb in Roux-en-Y gastric bypass improves weight loss in the first years after surgery: results of a randomized controlled trial. Obes Surg. 2018;28:3744–55. https://doi.org/10.1007/s11695-018-3421-7.

    Article  PubMed  Google Scholar 

  23. Shah K, Nergård BJ, Fagerland MW, Gislason H. Limb length in gastric bypass in super-obese patients-importance of length of total alimentary small bowel tract. Obes Surg. 2019;29(7):2012–21.

    Article  Google Scholar 

  24. Nergaard BJ, Leifsson BG, Hedenbro J, Gislason H. Gastric bypass with long alimentary limb or long pancreato-biliary limb–long-term results on weight loss, resolution of co-morbidities and metabolic parameters. Obes Surg. 2014;24(10):1595–602. https://doi.org/10.1007/s11695-014-1245-7.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Stemberg E, Szabo E, Göran Å, et al. Closure of mesenteric defects in laparoscopic gastric bypass: a multicentre, randomised, parallel, open-label trial. The Lancet. 2016;387(10026):1397–404.

    Article  Google Scholar 

  26. Kim J, Azagury D, Eisenberg D, et al. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. ASMBS POSITION STATEMENT. 2015;11(4):739–48. https://doi.org/10.1016/j.soard.2015.05.001.

    Article  Google Scholar 

  27. Karampinis I, Lion E, Grilli M, Hetjens S, Weiss C, Vassilev G, Seyfried S, Otto M. Trocar site hernias in bariatric surgery-an underestimated issue: a qualitative systematic review and meta-analysis. Obes Surg. 2020;30(7):2860. https://doi.org/10.1007/s11695-018-03687-2.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Visceral Surgery Unit, CHU UCL Namur, Site de Dinant, Rue Saint-Jacques 501, 5500, Dinant, Belgium

    Jean-Philippe M. M. K. Magema

  2. Visceral Surgery Unit, Delta CHIREC Hospital, Site Delta, Boulevard du Triomphe 201, 1160, Brussels, Belgium

    Jacques Himpens

Authors
  1. Jean-Philippe M. M. K. Magema
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jacques Himpens
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean-Philippe M. M. K. Magema.

Ethics declarations

This article does not contain any studies with human participants or animals performed by any of the authors.

Ethical approval

For this type of document, formal consent is not required, and informed consent does not apply.

Conflict of Interest

The authors do not have any conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Magema, JP.M.M.K., Himpens, J. “What Really Matters When Performing a Laparoscopic Roux-en Y Gastric Bypass?” Literature-Based Key Steps Towards Success and Standardization of the Procedure. OBES SURG 31, 5441–5445 (2021). https://doi.org/10.1007/s11695-021-05750-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-021-05750-x

Keywords

Search

Navigation