title: Combined laparoscopic/endoscopic anvil placement for the performance of the gastroenterostomy.
abstract: BACKGROUND
  We developed the laparoscopic gastric bypass in 1993 and first reported the technique and results in 1994. The technique for the gastroenterostomy was derived from the method used in the percutaneous endoscopic gastrostomy tube placement. Some have questioned the safety of this technique, and alternatives have been proposed.
  
  
  METHODS
  Prospectively, we have followed and recorded the results of our laparoscopic patients. To date we have performed over 1,400 laparoscopic gastric bypass operations using the same technique of anvil placement: pulling the anvil down from the mouth to the stomach pouch with a percutaneously placed wire. All patients underwent upper GI endoscopy following the anvil placement, and a water-soluble upper GI series was obtained on the first postoperative day.
  
  
  RESULTS
  There have been no esophageal injuries in the first 1400 patients on whom this technique was done.
  
  
  CONCLUSIONS
  The percutaneous pull-wire technique is a safe and effective method to place the 21-mm circular stapler anvil for the performance of a laparoscopic gastroenterostomy.
authors.affiliation: Alvarado Hospital and Medical Center, San Diego, CA, USA. acwmd@gastricbypass.com
authors.forename: A C
authors.initials: AC
authors.lastname: Wittgrove
authors.forename: G W
authors.initials: GW
authors.lastname: Clark
mesh_terms: D005763:Gastroenterostomy / Q000379:methods* / Q000592:standards; D006801:Humans; D010535:Laparoscopy; D011446:Prospective Studies; D017792:Surgical Stapling / Q000295:instrumentation*