Purpose: Laparoscopic Roux-en-Y gastric bypass is quickly replacing open techniques in the morbidly
obese patient who presents for surgical treatment. Safety concerns about the laparoscopic technique
have arisen in the literature with gastrojejunostomy leak rates of 5% or greater reported in
several series.
Materials and Methods: A total of 251 consecutive gastric bypass operations were performed from
August 2001 to January 2004 by a single surgeon with over 6 years' experience. A double layer technique
was used for every gastrojejunostomy anastomosis. This consisted of end-to-side stapled anastomosis
using only 30 mm of a 45 mm blue (3.5 mm) staple cartridge that was fired inside the gastric
pouch and Roux limb. A posterior running suture was then used to reinforce the back wall. An
intraluminal 32F bougie was placed before the stapler opening was closed. Finally, 2 running sutures
were used to reinforce the anterior and lateral sides of the anastomosis.
Results: The average patient age was 43 years (range, 18–67 years), 89% were female, average
preoperative weight was 137 kg (range, 89.5–214.5 kg), and average body mass index of 49 kg/m2
(range, 35–75). One hundred forty-two cases were performed with the Ethicon endoscopic linear
stapler and 109 with the United States Surgical endoscopic linear stapler. There were no anastomotic
leaks, staple line leaks, pulmonary emboli, or in-hospital deaths recorded. Endoscopic dilation
successfully treated 10 (4%) cases of stomal stenosis. Eleven (4%) patients developed marginal
ulcers that were easily treated with a proton pump inhibitor. Average excess weight loss at 12 months
and 18 months was 63% and 71%, respectively.
Conclusions: Laparoscopic results are as good as or better than open surgery in the morbidly
obese patient. The learning curve for this operation is steep and this may be reflected in the higher
leak rates reported in earlier series. However, the technique used to create the gastrojejunostomy
anastomosis may also account for a lower leak rate. The two-layer gastrojejunostomy anastomotic
technique combines an inner stapled layer and outer sutured layer that yields excellent results.
