Gastric Bypass for Morbid Obesity: a Standard Surgical Technique by Consensus |
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Authors: | John Talieh MD Daniel Kirgan MD Barry L Fisher MD |
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Institution: | (1) The Department of Surgery, University of Nevada School of Medicine, Las Vegas, NV, USA;(2) The Department of Surgery, University of Nevada School of Medicine, Las Vegas, NV, USA;(3) The Department of Surgery, University of Nevada School of Medicine, Las Vegas, NV, USA |
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Abstract: | Background: The gastric bypass operation has evolved since 1966 when it was first introduced. The purpose of this study was
to determine the present state of gastric bypass by consensus among the members of the American Society for Bariatric Surgery
(ASBS). Method: A questionnaire was sent to all members of the ASBS. Forty-three percent responded reporting over 41,200 cases.
Results: Results were analyzed by using χ2 tests with a null hypothesis. Surgeons agreed on several technical aspects, preferring a vertical to a horizontal stapleline;
estimating, rather than measuring, the pouch volume at an average of 22 cc. Few surgeons divide the short gastric vessels,
and only 25% of surgeons polled use a restrictive ring or band proximal to the gastroenterostomy. Most surgeons calibrate
the gastroenterostomy, reporting a preferred average diameter of 12.3 cm. There was no consensus regarding forming the gastroenterostomy,
58% preferring hand-sewn and 42% stapled anastomoses. There was no consensus regarding dividing the gastric pouch from the
bypassed stomach: Conclusion: The preferred gastric bypass is vertical, with the pouch estimated at 20-25 cc, and the gastroenterostomy
calibrated at 12 mm diameter. The short gastric vessels need not be divided, and restrictive bands or rings are not preferred.
This technique of gastric bypass should be used as the control procedure when modifications are tested in future trials. Randomized
prospective studies are suggested to probe the benefits of division of the stomach pouch from the bypassed stomach. |
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Keywords: | Gastric bypass morbid obesity obesity surgery surgical techniques |
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