Laparoscopic Roux-en-Y gastric bypass using the porcine model.
BACKGROUND
The laparoscopic Roux-en-Y gastric bypass (LRYGBP) may be performed using a variety of methods. The purpose of this study was to learn how to perform the Roux-en-Y gastric bypass operation laparoscopically, using a porcine model.


METHODS
11 domestic pigs (mean weight 47 kg) underwent LRYGBP. In 8 animals, a completely laparoscopic approach was attempted, while in 3 animals a hand-assist device was used. Techniques for anvil placement, pouch calibration, and limb-length measurement were evaluated. Animals were sacrificed at the end of the procedure, and operative results were recorded.


RESULTS
The hand-assist device restored tactile feedback but obscured visualization. The gastrojejunostomy leak rate was 64%, and the jejunojejunostomy leak rate was 73%. Anvil placement using transgastric and transoral methods was feasible. Calibrating the pouch with a Baker's tube was more accurate than using anatomical landmarks. Measuring limb-lengths using Babcock clamps was reliable with practice.


CONCLUSIONS
The frailty of the porcine small intestine may limit one's ability to achieve intact anastomoses. Despite the anatomic limitations, the porcine model was well-suited for skill development and evaluation of techniques for performing the LRYGBP operation.
Scott
D J
DJ
Southwestern Center for Minimally Invasive Surgery, University of Texas Southwestern Medical Center, Dallas 75390-9092, USA.
Provost
D A
DA
Tesfay
S T
ST
Jones
D B
DB
D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D000818:Animals; D004195:Disease Models, Animal; D015390:Gastric Bypass / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D007582:Jejunostomy / Q000009:adverse effects / Q000379:methods; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D009767:Obesity, Morbid / Q000601:surgery; D013270:Stomach / Q000601:surgery*; D013536:Suture Techniques; D013537:Sutures; D013552:Swine; D016896:Treatment Outcome