Laparoscopic gastric bypass: Hand-sewn gastrojejunostomy technique

Abstract

The laparoscopic gastric bypass with hand-sewn anastomosis continues to be one of the most challenging surgical procedures performed today. The long learning curve is twofold. First, it is adopting an operative style that is entirely surgeon-centric. It does not rely upon the skill of the assistant to present the anatomy in a precise manor to enhance operative efficacy. It does require the surgeon to control the entire operative field, including the surgical assistant and camera driver. Second, it is dependent on the surgeon mastering intracorporeal suturing technique, preferably without the use of suturing assistant devices.However, this technique is reproducible and can be used in almost every operative environment or patient situation. It also forces the surgeon to develop the skills and experience to deal with almost all postoperative complications laparoscopically, without the need for open conversion, which translates to superior outcomes in terms of wound morbidity, cardiovascular compromise, and immune function (Mastery of endoscopic surgery and laparoscopic surgery, Lippincott Williams & Wilkins, Philadelphia, pp 22-38; J Am Coll Surg. 192, 469-76, 2001). The laparoscopic Roux-en-Y gastric bypass with hand-sewn gastrojejunostomy transcends a simple technique of performing an anastomosis; it represents an evolution toward the advancement of minimally invasive strategy.