Table 2

Overview of operative steps of laparoscopic Roux-en-Y gastric bypass

Splitting omentumThe omentum may be divided to facilitate tensionless positioning of the bowel during the creation of the gastrojejunal anastomosis
Measuring biliopancreatic limbStarting at the ligament of Treitz the small bowel is measured distally to a length of approximately 40–60 cm and divided
Creating the jejunojejunostomyFollowing the division of the bowel, the alimentary limb is measured out (75–150 cm). The biliopancreatic limb is reconnected to the alimentary limb at this measured point. The reconnection of the two bowel segments is termed the jejunojejunostomy
Gastric pouch creationThe stomach is partially divided in a horizontal angle at the level of the lesser curve. From this division line, the stomach is then transected in a vertical fashion up to the angle of His to result in a small residual stomach pouch
Gastrojejunostomy creationThe new stomach pouch is reconnected to the bowel (alimentary limb/Roux-limb). This new connection is termed gastrojejunostomy.
Mesenteric closureThe defect between the two transected mesentery edges is sutured closed to prevent internal herniation of bowel
  • The steps described can be performed in a varying order and represent only a basic overview of the procedure. The steps of measuring biliopancreatic limb, jejunojejunostomy, gastrojejunostomy or pouch creation can be further subdivided into several smaller steps as detailed in a prior hierarchical task analysis.16