R Rutledge, MD. Centers for Laparoscopic Obesity Surgery
Introduction:
There is a growing body of evidence showing that the Mini-Gastric Bypass (MGB) is a safe and effective alternative to other bariatric surgical operations. Repeated randomized controlled trials show the MGB outperforms comparable bariatric procedures. This video describes the technique of performance of the MGB.
Methods: A video demonstration of the steps in performance of the MGB. The surgery is simple and requires only 2 people the surgeon and the scrub tech.
Results: The average operative time was 39 minutes, and the median length of stay was 1 day. Procedure: Port placement: 5 ports, 4 12mm ports and 1 5mm ports. Retraction of the liver is followed by skeletonization of the lesser curvature of the stomach at the Crow’s foot, the junction of the body and the antrum of the stomach. Beginning on the lesser curvature at the Crow’s foot two staplers (30mm and 45mm) fired perpendicular to the lesser curvature.
A 28 French “guide tube” is placed along the lesser curvature to “size” the gastric pouch. Parallel to the lesser curvature a staple line is extended from the Crow’s foot to the esophago-gastric junction.
Then attention turns to the bypass portion of the case. The transverse colon is retracted cephalad. The ligament of Trietz is identified and the bowel is run in 1.2 inch steps to bypass between 3 to 8 feet of small bowel based upon the patient’s starting weight.
The gastro-jejunostomy (GJ) anastomosis is begun. A gastrotomy and jejunostomy are created.
An Endo-GIA is passed into the the stomach and small bowel. The gastro-jejunosotmy is formed firing the Endo-GIA.
The “guide tube” is advanced across the anastomosis to act as a stent and help avoid a stricture.
Four stay sutures are placed to pull the gastric and jejunal tissue up into the jaws of the stapler
the Endo-GIA is fired to close the GJ. A corner stitch is placed at the lateral corner of the GJ
The GJ is flipped and a continuous suture is run around the GJ reinforcing the anastomosis.
The operation is now completed and the ports removed and the skin is closed with clips
Conclusions: Several randomized controlled prospective trials confirms that the MGB out performs comparable bariatric procedures. The MGB is safe, reversible and revisable, results in a marked decrease in perceived hunger and increased satiety with major weight loss, it has a short operating-time, and a significantly shorter hospital stay than the RNY. The MGB appears to meet many of the criteria of an “ideal” weight loss operation.
Session Number: Poster – Poster Presentations
Program Number: P442
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