The Micropouch Gastric Bypass: Technical Considerations in Primary and Revisionary Operations

Abstract

With an appreciation for the finer anatomy of the proximal stomach and intra-abdominal esophagus, the micropouch can be constructed safely in both primary and redo procedures. The MGB, now in its seventh year, is durable and has, with rare exception, eliminated pouch enlargement, staple-line separation, reflux esophagitis, and marginal ulceration.

Laparoscopic adjustable gastric banding for massive superobesity ( > 60 body mass index kg/m 2 )

“…This patient was converted to BPD at 27 months. Again, this mirrors our longer term follow-up from less obese patients having had banding [34]. This success may well be due to our technique of band placements, but it is also due to adjustment techniques, which are based on easy access the surgeon and slow, steady adjustment, usually beginning with low volumes and adjusting based on hunger and satiety.…”

Wireless pH-metry at the gastrojejunostomy after Roux-en-Y gastric bypass: a novel use of the BRAVO™ system

“…We have previously demonstrated the invariable presence of parietal cells in the cardiac region [27], making the construction of a nonacid-producing gastric pouch impossible. Sapala et al [28] have had a low incidence of stomal ulcers when using a micropouch, and we agree that every effort should be made to reduce the size of the pouch and, by this, the amount of acid-producing parietal cells. Believing in the acid hypothesis, it is understandable that peptic ulcers can arise promptly in the proximal jejunum after RYGBP, because this segment is normally only exposed to a neutral environment.…”

Laparoscopic sleeve gastrectomy for the super-super-obese (body mass index >60 kg/m2)

“…Experience with this began when gastric dilation was observed after M & M procedures, but it was avoided after techniques of micropouch creation for gastric bypass. 5,17,19 In our experience, lasting weight loss can be achieved after SG if a bougie no larger than 42 F is used in the primary treatment of morbid obesity. In patients who are candidates for BPD-DS as a single stage operation, we use a 60-F bougie as the restriction obtained with a smaller bougie combined with duodenoileostomy is too severe for most patients to tolerate.…”