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Operative Technique |

Triple-Stapling Technique for Jejunojejunostomy in Laparoscopic Gastric Bypass

Atul K. Madan, MD; Constantine T. Frantzides, MD,PhD
Arch Surg. 2003;138(9):1029-1032. doi:10.1001/archsurg.138.9.1029.
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Since its introduction in 1994,1 laparoscopic gastric bypass has become an increasingly popular procedure for the surgical treatment of morbid obesity. In fact, it has been stated that the most prevalent laparoscopic bariatric procedure in the United States is the gastric bypass.2 Multiple studies have demonstrated the safety and efficacy of this procedure.35 One well-designed prospective randomized study by Nguyen et al6 comparing the laparoscopic approach with the open approach showed a shorter convalescence, a shorter hospital stay, and less blood loss with the laparoscopic gastric bypass. In addition, the patients who underwent this procedure had more rapid improvement in their quality of life and an amount of weight loss comparable with that of the patients in the open group.

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Figures

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Figure 1.

Diagram demonstrates the stenosis that can occur when using the double-stapling technique.

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Figure 2.

Two enterotomies are placed in each limb of the bowel. The enterotomy in the limb from the duodenum is placed 5 cm from the transected end.

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Figure 3.

A laparoscopic linear cutter (from the umbilical port) is placed into the antimesenteric side of the 2 limbs.

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Figure 4.

To position the bowel, it is rotated 90° and cephalad.

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Figure 5.

A laparoscopic linear cutter (from the left lateral port) is placed into the antimesenteric side of the 2 limbs. This firing is 180° from the firing position of the original staper.

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Figure 6.

Another laparoscopic linear cutter (from the umbilical port) is used to close the common enterotomy.

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Figure 7.

Anastomosis is demonstrated with no evidence of stenosis.

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