Laparoscopic gastric bypass for morbid obesity with linear gastroenterostomy.
BACKGROUND
Laparoscopic gastric bypass (LGBP) is a well-established procedure for the surgical management of morbid obesity. Most surgeons create the gastroenteral anastomosis by using the circular EEA stapler. We describe an alternative laparoscopic anastomotic technique using the EndoGIA linear stapling device.


METHODS
The stomach was proximally transected with a linear stapler (45 mm, Endo-GIA) to create a 15 to 20 ml pouch. Next, an antecolic Roux-en-Y gastroenterostomy was performed, using the 45 mm Endo-GIA. The proximal loop of the intestine was then separated from the anastomotic site by the Endo-GIA. Finally, the Endo-GIA was used for the intraabdominal creation of a side-to-side enteroenterostomy.


RESULTS
Between June and August 2001, 5 patients with mean BMI 56.7 kg/m(2)+/-7.3 underwent LGBP. All patients were seen 6 months post-surgery. Operating time was 7.5 and 6.5 hours for the first 2 operations, but was under 4.5 h for the next 3 cases. 1 patient suffered from perioperative hypoxia leading to long-term artificial respiration. 6 weeks after surgery, 1 patient developed obstruction due to torsion of the enteroenterostomy and required open revision. The 3 remaining patients made an uneventful recovery. All patients lost considerable weight (mean 36.5 kg; [range 32 to 45] after 6 months). No stenosis or anastomotic leakage was noted.


CONCLUSIONS
A linear stapled anastomosis is an alternative to the use of the circular stapler.
Korenkov
M
M
Surgical Clinic, 2nd Department of Surgery, University of Cologne, Germany. michael.korenkov@uni-koeln.de
Goh
P
P
Yücel
N
N
Troidl
H
H
D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D005763:Gastroenterostomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D018570:Risk Assessment; D012494:Sampling Studies; D013528:Surgical Staplers; D016896:Treatment Outcome; D015431:Weight Loss