title: Laparoscopic transumbilical gastrojejunostomy: an advanced anastomotic procedure performed through a single site.
abstract: BACKGROUND
  Single-site laparoscopic surgery and natural orifice transumbilical surgery (NOTUS) have become exciting areas of surgical development. However, most reported case series consist of basic laparoscopic procedures, such as cholecystectomy and appendectomy. In this paper, we present the case of an advanced laparoscopic operation-construction of a gastrointestinal anastomosis-that was performed through ports placed entirely within the umbilicus.
  
  
  METHODS
  In this paper, we describe a 61-year-old male with a history of advanced pancreatic carcinoma who was referred with a gastric outlet obstruction. A laparoscopic gastrojejunostomy bypass, using a linear stapler with suture closure of the enterotomy, was performed through three abdominal trocars placed entirely within the umbilicus. Some potential advantages of NOTUS palliative gastrojejunostomy include reduced postoperative pain and the lack of visible abdominal scars.
  
  
  RESULTS
  The operation was completed uneventfully in 40 minutes. The patient recovered without complications and was discharged on postoperative day 2. At 1-month follow-up, the patient had improved oral intake without any further vomiting symptoms.
  
  
  CONCLUSIONS
  This case report documents the feasibility of an advanced anastomotic gastrojejunostomy procedure which can be performed through a single site. However, benefits of this approach, compared to conventional laparoscopic procedures, will require a prospective randomized clinical trial.
authors.affiliation: Departments of Surgery and Medicine, University of California Irvine Medical Center, Orange, California 92868, USA. ninhn@uci.edu
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
authors.forename: Johnathan
authors.initials: J
authors.lastname: Slone
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Reavis
authors.forename: James
authors.initials: J
authors.lastname: Woolridge
authors.forename: Brian R
authors.initials: BR
authors.lastname: Smith
authors.forename: Ken
authors.initials: K
authors.lastname: Chang
mesh_terms: D015390:Gastric Bypass / Q000379:methods*; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery