Staged laparoscopic Roux-en-Y: a novel two-stage bariatric operation as an alternative in the super-obese with massively enlarged liver

• Published in: Obesity surgery Vol. 15; no. 7; pp. 1077 - 1081
• Main Authors: Nguyen, Ninh T, Longoria, Mario, Gelfand, Dmitri V, Sabio, Allen, Wilson, Samuel E
• Format: Journal Article
• Language: English
• Published: United States Springer Nature B.V 01.08.2005
• Subjects: Anastomosis, Roux-en-Y; Bariatrics - methods; Gastric Bypass - methods; Hepatomegaly - complications; Humans; Laparoscopy; Obesity, Morbid - complications; Obesity, Morbid - surgery; Weight control
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1381/0960892054621062

In a subset of super-obese patients, the one-stage laparoscopic Roux-en-Y gastric bypass (RYGBP) can be associated with significant morbidity and mortality. In a previous effort to reduce the perioperative risks associated with the super-obese, a two-stage operation was devised. This two-stage operation consisted of a sleeve gastrectomy (1st stage) followed by a RYGBP or duodenal switch procedure (2nd stage). We find that the primary limiting factor making laparoscopic gastric bypass challenging in the super-obese is the volume of the left lobe of the liver. A greatly thickened left lobe of the liver obscures visualization of the gastroesophageal junction and angle of His so that a sleeve gastrectomy is difficult to construct. In this report, we describe a novel method utilizing a staged Roux-en-Y procedure. Instead of performing a restrictive operation (sleeve gastrectomy) as the initial procedure, we fashion a modified Roux-en-Y with a low gastrojejunal anastomosis and a larger gastric pouch encompassing the gastric fundus. The low anastomosis obviates the need for exposure of the gastro-esophageal junction and angle of His. At the 2nd stage procedure, completion sleeve gastrectomy of the gastric fundus is performed at an interval of 6-12 months after the 1st stage operation.