Overview of operative steps of laparoscopic Roux-en-Y gastric bypass
| Steps | Description |
|---|---|
| Splitting omentum | The omentum may be divided to facilitate tensionless positioning of the bowel during the creation of the gastrojejunal anastomosis |
| Measuring biliopancreatic limb | Starting at the ligament of Treitz the small bowel is measured distally to a length of approximately 40–60 cm and divided |
| Creating the jejunojejunostomy | Following 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 creation | The 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 creation | The new stomach pouch is reconnected to the bowel (alimentary limb/Roux-limb). This new connection is termed gastrojejunostomy. |
| Mesenteric closure | The 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