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  • 1. Endoscopy/Port Placement
  • 2. Lysis of Adhesions and Hiatal Dissection
  • 3. Vagotomy
  • 4. Hiatal Hernia Repair
  • 5. Division of Roux Limb
  • 6. Partial Gastrectomy/Resection of Ulcer
  • 7. Rerouting of Roux Limb
  • 8. New GJ Anastomosis
  • 9. Endoscopy for Testing of Anastomosis
  • 10. Closure
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Laparoscopic Gastric Bypass Revision

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Deborah D. Tsao, BS1; Janey Sue Pratt, MD2
1Medical Student, Stanford University School of Medicine
2Massachusetts General Hospital

Procedure Outline

General anesthesia achieved in the operating room.

Patient positioned supine with pressure points padded and foot support at end of bed to allow deep reverse Trendelenburg.

positioning
  • Mobilization of Liver
  • Hiatal dissection
  • Identify and divide posterior Vagus nerve
  • Identify and divide anterior Vagus
  • Identify GE junction
  • Placement of sutures
  1. Remove adhesions and mesentery
  2. Dissection of Stomach
  3. Division of Gastric remnant
  4. Dissection of remnant off of pouch
  5. Dissection of remnant/pouch/roux limb confluence (resection of ulcer)
  6. Completion of remnant dissection
  1. Oversew staple line of remnant
  2. Mobilize Jejunal mesentery
  3. Evaluation of Jejunal anastomosis
  4. Evaluation of Jejunal common channel
  5. Division of attachments of roux limb to mesocolon
  6. Identification of Ligament of Treitz/creation of mesocolonic window
  7. Passage of Jejunum through transverse mesocolon
  1. First layer of anastomosis
  2. Testing of anastomosis
  3. Second layer of anastomosis
  • Close mesenteric defects
  • Remove specimen
  • Close port sites