Reduced Port Laparoscopic Roux-en-y Gastric Bypass with Manual Gastrojejunostomy

Giovanni Dapri, MD, PhD, FACS. European School of Laparoscopic Surgery, Brussels, Belgium.

Background: The philosophy to reduce the invasiveness of minimal access surgery invested the last years of general laparoscopy. Single incision laparoscopic surgery (SILS) has been reported to be feasible and safe. Reduced port laparoscopic surgery (RPLS) consists in performing conventional multiport laparoscopic procedures through a reduction in port number and size. In morbid obesity surgery, since patients undergo plastic reconstruction during follow-up, and the umbilicus is not a landmark and associated to wound complications due to adipose tissue, RPLS appears more valuable than SILS.

Video: A 21-year-old woman was admitted to the centre for morbid obesity. Her preoperative weight was 117 kg and her BMI was 40 kg/m2. A reduced port laparoscopic Roux-en-Y gastric bypass (RPLGB) was proposed. The patient was placed legs apart on the operating table and the surgeon stood between her legs. Three ports were placed: a 12-mm port in the umbilicus, a 5-mm port in the right flank, and a 5-mm port in the left flank. A 10-mm, 30-degree scope was introduced into the 12-mm port which remained there throughout the procedure except during the insertion of the roticulator linear stapler when the scope was switched to a 5-mm, 30-degree one and introduced into the 5-mm left flank port. A percutaneous stitch was placed at the apex of the right crus in order to retract the left liver lobe. A conventional Roux-en-Y gastric bypass with manual end-to-side one-layer gastrojejunostomy (length of alimentary limb: 50 cm) and linear mechanical side-to-side jejunojejunostomy were performed, including closure of mesenteric and Petersen’s spaces.

Results: Operative time was 120 minutes and blood loss was unsignificant. Postoperative pain was controlled by paracetamol (4 g/day) used during the first 24 hours only. Patient discharge was allowed after 72 hours.

Conclusions: RPLGB for morbid obesity offers favorable cosmetic results in addition to reduced abdominal trauma and postoperative pain.