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Three Steps to the Laparoscopic, Robotic Assisted, Gastric Bypass

Performed and narrated by Dr. Snyder 
1. Formation of the Small Gastric Pouch

The first thing that is done in performing a gastric bypass is the creation of a small gastric pouch that will create restriction.  This is done using staplers that form staple lines and cuts between them.  The creation of the gastric pouch can take anywhere between 10 to 30 minutes depending on the patient's anatomy.  This is the most critical part of the operation.  A good gastric pouch is needed for good long term success after surgery.  If it is left too large, weight regain could be a problem for the patient in the future.

2. Creation of the Gastro-Jejunostomy

The gastro-jejunostomy is the formation of the connection between the newly created small gastric pouch and the small intestines.  About 75 cm (1.5 feet) of small intestines is brought up to the small pouch and two layers of suture are using to connect the pouch and the intestines.  Then the bowel in divided and the bypass portion (roux limb) is created.  It is usually 150 cm (3 feet) in length.  This bypass portion of the operation provides the mal-absorption and hormal effects of the operation.

3. Creation of the Jejuno-Jejunostomy and Closure of Mesenteric Defect

Once the bowel is divided and the roux limb is made to length, the bowel is put back together.  Holes are put into each side of the bowel, and the stapler forms a solid connection between them.  The common defect left by this is closed with a single layer of suture.  The mesentery is the blood supply to the bowel, and mocing the intestines causes and abnormal space that must be closed to prevent hernia (a space that other intestines can get into and cause pain or bowel strangulation).  This is the last step.

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