Transumbilical Laparoscopic Roux-en-Y Gastric Bypass with Hand-Sewn Gastrojejunal Anastomosis

Abstract

Single-port laparoscopic surgery has undergone significant development over the past 5 years. Single port is used in various procedures, including bariatric surgery. The aim of this paper is to describe a surgical technique for gastric bypass with a transumbilical approach (transumbilical gastric bypass-TUGB) with hand-sewn gastrojejunostomy, in selected patients who may be benefited by a better cosmetic result. The procedure begins with a transumbilical vertical incision. We use the GelPOINT single-port device and a 5-mm assistant trocar in the left flank (in the first two cases, a 2-mm subxiphoid liver retractor was used). A gastric pouch is made and calibrated with a 36-Fr bougie. The gastrojejunal anastomosis is performed by hand-sewing in two layers. A Roux-en-Y with a biliary limb of 50 cm and an alimentary limb of 120 cm is performed with a stapler. Three women were subjected to TUGB. The women were aged 28, 31, and 42 years; they had body mass indexes of 40.3, 33, and 38.2; and the operating times were 150, 200, and 150 min, respectively. The first two women underwent a Roux-en-Y gastric bypass (RYGB), and the last woman underwent a RYGB with a resection of the stomach remnant. There were no conversions to open or multitrocar techniques. No complications or deaths occurred. The three patients were satisfied with the cosmetic result. The technique described for TUGB is a feasible procedure for surgeons who have previous experience with the transumbilical approach.

Transumbilical Roux-en-Y gastric bypass in morbidly obese patients: A systematic review

“…On the other hand, making one or two extra incisions apart from the main umbilical one, may not require special devices and instruments and it presents less potential for the development of postoperative hernias [21]. It should also be pointed out that somatometric characteristics such as BMI and the distance between the umbilicus and the epigastric area, have to be taken into consideration in order to provide an individualized approach to each patient [12].…”

“…General characteristics of the eligible studies and patient demographics are summarized in Table 1. Six of the eligible studies were prospective cohort studies of relatively low quality (were characterized on average by six stars in the Newcastle Ottawa scale) [5,7,13,14,16,18], while the rest were either case report (n ¼ 2) [9,15] or case series (n ¼ 2) [12,17]. The mean age of the patients was 37.3 years (range, 19e55 years), and 79.4% (n ¼ 196) of them were female.…”

Laparoscopic single-incision gastric bypass: initial experience, technique and short-term outcomes

“…Varela et al reports using multi-access port devices, which require a 3 cm incision above the umbilicus [ 8 ]. Fernandez et al [ 9 ] and Merchant et al [ 10 ] report using a gel-port device with three pre-installed trocars and one additional metal trocar for liver retraction. In our cases we preferred to access through vertical skin incision within the umbilicus for port placement.…”

Laparoendoscopic Single-Site Bariatric Surgery: A Review of Single-Port Laparoscopic and Endoscopic Bariatric Treatments

“…BPD is not often performed in our institution and it is only really considered in cases of extreme morbid obesity. Known reports of single-port bariatric procedures are briefly summarized in Table 1 9,13,14,17,24,28,30,31,34–41…”