The Technique of Roux-en-Y Gastric Bypass on Vertical Banded Gastroplasty in Open Surgery

Background After 5 years experience on 288 patients, the Roux-en-Y gastric bypass on vertical banded gastroplasty (RYGB-on-VBG) has been demonstrated effective, in which traditional endoscopic and X-ray study of the gastric remnant can be done. The video shows laparotomic technique for this gastric bypass that avoid the complete stomach exclusion, where the gastro-gastric outlet allows an access from the stapled gastric pouch into the distal stomach. Methods Through an upper midline incision, a 30 cm3 vertical gastric pouch is fashioned with a 25 mm circular and 90 mm four-row stapler, standardized by using the dedicated steel instrument. The gastric outlet is encircled by a soft elastic band, always calibrated up on a tube of 36 Fr introduced into the stomach. The jejunum is sectioned at 30 cm from the ligament of Treitz with linear cutter stapler. A hand sewn side-to-side gastrojejunostomy is performed proximal to the gastrogastric outlet, with a 150 cm Roux limb placed upward through mesocolon. A hand sewn side-to-side jejuno-jejunostomy with the biliary limbs completed the RYGB-on-VBG. The mesenteric defects are closed, and abdominal drainage is placed near the gastrojejunostomy. Results The average operative time was 140 min, and the mean hospitalization was 8 days. Of 288 patients with follow-up of 90%, the weight loss outcome was similar to traditional RYGBP, and surgical complications were 0.3%. For each patient followed, radiography or gastroscopy have provided the details of post-surgical anatomy of the distal stomach. Conclusion RYGB-on-VBG performed in open surgery is an effective and safe bariatric operation.