Fully Stapled Gastric Bypass with Isolated Pouch and Terminal Anastomosis: 1-3 Year Results

Background: Roux-en-Y gastric bypass is a bariatric procedure of choice.There is evidence supporting a small isolated pouch and a wide anastomosis. Gastric vascular anatomy renders the ventral aspect less suited for anastomotic construction.The lesser curvature has abundant blood supply that should preferably not be interfered with. Terminal anastomosis is a logical choice. Methods: We devised a way of making a fully stapled gastric bypass with complete separation of a pouch that empties dependently.The technique obviates the oral passage of the stapler anvil. Such a procedure facilitates the creation of an "end-of-pouch to end-of-jejunal limb" wide-diameter anastomosis and precludes the risk of staple-line disruption. Results: Since October 1997 we have performed 227 such anastomoses (146 primary, 81 reoperative procedures) in consecutive patients with no leaks, no gastro-gastric fistulas and no mortality.The postoperative hospital time was 3.6 (3-8) days (median, range). In primary operations baseline BMI was 47.5, 1-yr 29.7 and 3-yr 29.2. Corresponding values for reoperations were 39.3, 30.8 and 31.5. Weight loss was adequate, and complications were limited to three anastomotic ulcers and two narrow stomas without visible ulcers but necessitating endoscopic dilatation. Conclusion: The technique confers distinctive advantages.