Omental Wrap: A Simple Technique for Reinforcement of the Gastrojejunostomy during Roux-en-Y Gastric Bypass

Abstract

Anastomotic leak is one of the most dreaded complications following Roux-en-Y gastric bypass (RYGBP). A simple technique for reinforcement of the gastrojejunal anastomosis using an omental wrap during laparoscopic RYGBP is described. We recommend this technique particularly in those patients at high risk for gastrojejunal leak. A 20 ml vertically-oriented gastric pouch, based on the lesser curvature of the stomach, is created using linear cutter staplers (endo-GIA). The gastrojejunal anastomosis is reinforced with an omental wrap (omental flap). The jejunojejunostomy is created 100-150 cm from the gastrojejunostomy, depending on the BMI. 124 laparoscopic RYGBPs were performed by the same surgeon. The omental wrap was successfully performed in all patients but two. There were no mortalities, leakages, or stenoses noted during follow-up. During RYGBP, reinforcement of the gastrojejunostomy with an omental wrap is a simple, feasible, and protective adjunctive maneuver that can minimize the risk of gastrojejunal leak.