The learning curve for LRYGB has no mortality and an acceptable complication rate. The operating time and morbidity rate are the indicators for overcoming the learning curve.
Jejunostomy is the recommended route for enteral nutrition in certain patients. Various methods and equipment had been proposed to complete the operation laparoscopically. The method we proposed is based on the triangular rule of trocar orientation with typically available tube and equipment. It minimized the wounds to one 11mm trocar for the laparoscope plus two 5mm trocars for intracorporeal suturing, by creating the jejunostoma with straightforward surgical blade penetration. Sixty-nine patients underwent the operation as either a solitary procedure or a part of the operation based on preoperative indications. The majority of the patients received feeding within 3 day after operation (84%) without major complications. Fifteen patients experienced tube dislodgement or occlusion during the follow up but did not encounter difficulty while exchanging new tubes. The method we proposed could be done with readily available equipment and minimized wounds and did not yield major complications.
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