Technical Alternatives Laparoscopic Distal Gastric Bypass for Morbid Obesity in a Porcine Model

Abstract

Laparoscopic gastric bypass and vertical banded gastroplasty are two procedures used in the treatment of morbid obesity. The authors describe alternative techniques of laparoscopic distal gastric bypass as a modification of the Scopinaro procedure, which were used experimentally in a porcine model. Five pigs were used. The laparoscopic procedure was performed with the pigs under general anesthesia after pneumoperitoneum had been achieved. Five or six trocars were used. One port was converted from 12 to 33 mm, and all the other ports were 10-11 mm. The initial surgical technique was similar to that used by others for laparoscopic gastrectomy, except that atraumatic ultracision was used for all the dissection. The stomach was stapled with a linear cutter stapler (Endopath, 31 mm) to create a 50-ml pouch. The ileum was divided with a linear cutter-stapler (Endopath, 31 mm) or ultracision cautery. A long length of ileum was positioned between the stomach pouch and the jejunoileostomy. Only 50-70 cm of terminal ileum was preserved as a common channel. In three animals, the circular stapler (ILS, 21 mm) was used to produce an end-to-side anastomosis. In one animal, two purse-string sutures were handsewn in the ileum and jejunum stumps, and in another two animals, two endoloops were used for the anvil. In two animals, the linear stapler was used to form a side-to-side pouch stomach-ileum and jejunoileostomy anastomosis. In other animals, the two types of anastomosis have been combined. All animals were killed after surgery so that the anastomoses could be evaluated for size and integrity. In all animals, with the circular and linear stapler, both 21 and 13-15 mm anastomoses were intact. Distal gastric bypass is feasible laparoscopically, with intact anastomoses.