title: Greater curve approach for laparoscopic gastric bypass: total stapler gastrojejunostomy.
abstract: BACKGROUND
  Gastric bypass is an established bariatric procedure that has undergone multiple modifications to improve its effectiveness. The side-to-side stapled technique is well recognized, but closure of the gastrotomy/enterotomy by the stapler can potentially narrow the Roux limb. Because of this, many surgeons will hand suture the closure of the gastrotomy/enterotomy. To obviate this difficulty, we inserted the linear stapler from the stomach's greater curvature, using a double-stapled anastomosis that minimized the need for hand suturing.
  
  
  METHODS
  We performed a retrospective analysis of 307 patients undergoing this technique for laparoscopic gastric bypass. The weight loss and 30-day morbidity and mortality were tabulated and compared with those in other published series.
  
  
  RESULTS
  Of the 307 patients, none died postoperatively. The overall 30-day morbidity rate was 15%. Two leaks from the gastrojejunostomy and 2 from the jejunojejunostomy (1.2%) developed. The mean percentage of excess weight loss was 34% at 3 months, 52% at 6 months, 73% at 1 year, 71% at 2 years, and 69% at 3 years.
  
  
  CONCLUSIONS
  The greater curve approach avoids Roux limb obstruction, minimizes the need for hand suturing, and uses standard trocar incisions. Our short-term follow-up results are similar to those of series of other techniques.
authors.affiliation: Abilene Diagnostic Surgical Associates, Abilene, Texas, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Frazee
authors.forename: Glennon
authors.initials: G
authors.lastname: Einspanier
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Wachtel
authors.forename: Eldo E
authors.initials: EE
authors.lastname: Frezza
mesh_terms: D000328:Adult; D000368:Aged; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D013528:Surgical Staplers; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome; D015431:Weight Loss