Open and Laparoscopic Approach of a New Surgical Technique, Which Enables Traditional Diagnostic Evaluation of the Bypassed Stomach: The Roux-En-Y Gastric Bypass on Vertical Banded Gastroplasty

Background Roux-en-Y Gastric Bypass on Vertical Banded Gastroplasty (RYGB-on-VBG) is a modification of the traditional Gastric Bypass (RYGB), developed to allow the endoscopical or radiological investigation of the excluded stomach. We present the surgical technique via open and with laparoscopic approach. Methods Through an upper midline incision, a 30 cc vertical gastric pouch was fashioned by using a 25 mm circular stapler and partitioning with a 90 mm four-row stapler. A Gore-Tex ™ thin band encircled the gastric pouchoutlet, of 1 cm in inside diameter. The jejunum was sectioned 30 cm from the Treitz with a linear stapler. A hand-sewn retro-colic side-to-side gastrojejunostomy, of 2 cm in inside diameter, was performed proximal to the gastro-gastric outlet, with a 150 cm Roux-limb. A hand-sewn side-to-side biliary-limb anastomosis completed the gastric bypass. The laparoscopic approach through 5 trocars, shows the following differences: the gastric window was created with a 21 mm circular stapler, inserted from the trocar incision on the right side; stomach was sectioned from the gastric window to the angle of His, using a 60 mm endo-GIA stapler; the ante-colic gastrojejunostomy was done with a 25 mm circular stapler, where the anvil was introduced from the mouth and the stapler through an enterotomy in the Roux-limb, then sutured with a 60 mm endo-GIA stapler which was used also to create the biliary-limb anastomosis. Results The procedure achieved outcomes comparable with those of the classic RYGB, while allows traditional studies of remnant. Conclusions RYGB-on-VBG has been safe for both, open and laparoscopic approach.