Abstract：
BACKGROUND:The lengths of the bypassed segments in the initial laparoscopic roux-en-Y gastric bypass (LRYGB) are usually a matter of the individual surgeon's routine. The literature is inconclusive about the association between the Roux limbs' length and weight-loss or malabsorption (Stefanidis et al. Obes Surg. 21(1):119-24, 2011); (Rawlins et al. Surg Obes Relat Dis. 7(1):45-9, 2011). However, jejunojejunal anastomosis (JJ) "redo" and Roux limb length revision could be considered for patients with a very short Roux limb and weight loss failure or for short common channel and malabsorption. Complications of JJ may also require revision. METHODS:In over 1000 LRYGBs since 2001, eight patients required JJ revision for failure to lose enough weight (n = 6), malabsorption (n = 1), and stricture (n = 1). Instead of completely taking down the JJ, a simple technique was evolved to keep the enteric limb continuity. In a following step, the biliopancreatic limbs have been transected from the JJ and reconnected proximal (for malabsorption) or distal (for weight loss failure). RESULTS:In this video, a step-by-step the laparoscopic technique for JJ revision and relocating the biliopancreatic limb is presented. Procedure takes 40-60 min to perform using four trocars and the hospital stay was 1-2 nights. No complications occurred during the procedures or postoperative period. CONCLUSIONS:Laparoscopic revision of JJ is feasible and safe and should be part of surgeons' options on the long-term management of patients post LRYGB.
journal_name
Obes Surgjournal_title
Obesity surgeryauthors
Spivak Hdoi
10.1007/s11695-015-1885-2subject
Has Abstractpub_date
2015-12-01 00:00:00pages
2461issue
12eissn
0960-8923issn
1708-0428pii
10.1007/s11695-015-1885-2journal_volume
25pub_type
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