MORBID OBESITY > Laparoscopic Gastric Bypass

Patient and Port position: Patient placed in modified Lloyd Davies position
Pneumoperitoneum is created by veress needle through 10 mm Supraumbilical skin incision which later on is converted into 10mm camera port.  5mm epigastric, 12 mm right upper quadrant, 5mm left upper quadrant, 5mm right iliac fossa and 5mm left anterior axillary line ports are placed.

Initial step is to visualize all quadrants of peritoneal cavity, liver surfaces and esophageal hiatus.
DJ flexure is localized. Roux limb is created by dividing jejunum 100 cm distal to DJ flexure. 150cm alimentary limb is prepared and side to side anastomosis between biliopancreatic limb and alimentary limb done by linear endo GI stapler (white).  Enterotomy closed by 3-0 PDS sutures. Retrogastric space dissected after opening lesser omentum near lesser curvature just below 2nd vessels .Dissection done at Angle of His. Small gastric pouch created by sequential firing of endo GI stapler (blue).

Alimentary limb anastomosed to gastric pouch (GJ anastomosis) by 45 mm linear endo GI stapler (blue) antecolically and enterotomy closed by 3-0 PDS sutures.  Leak test is done in the end.