Hand-Assisted Laparoscopic Roux-En-Y Gastric Bypass: Aspects of Surgical Technique and Early Results

Background: The efficacy of Roux-en-y gastric bypass (RYGBP) for morbid obesity is well documented. We investigated the role of the Hand-assisted laparoscopic technique for performing RYGBP. Methods: In an open series, 13 patients (all female, median age 38, BMI 45 kg/m2) underwent Hand-assisted laparoscopic RYGBP. The HandPort was introduced through an 8-cm right subcostal incision. The stomach was always completely transected.The Roux limb was made > 50 cm and brought to the proximal gastric pouch (4 x 3 cm) behind the colon and the excluded stomach. A circular stapler (no. 21) was used for the gastrojejunostomy, with the anvil introduced through a gastrotomy. Results: The HandPort device could be successfully placed and allowed good working conditions in all patients. Median duration of surgery (including learning-curve time) and postoperative hospital stay were 205 min and 5 days, respectively. The amount of morphine needed (PCA) during postoperative day 1-3 were 45, 32 and 18 mg, respectively. One patient (8%) was converted to full laparotomy for safe closure of a small perforation of the proximal gastric pouch caused by the anvil of the circular stapler. All patients made an uneventful recovery. Two patients needed endoscopic dilatation of a relative stricture at the gastrojejunostomy. Conclusion: We believe that Hand-assistance makes Lap-RYGBP faster and safer without losing the essential benefits of total laparoscopy.