Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

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

Background

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Fernandez AZ Jr, DeMaria EJ, Tichansky DS et al. Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity. Ann Surg 2004; 239: 698–703.

  2. 2.

    Livingston EH. Complications of bariatric surgery. Surg Clin North Am 2005; 85: 853–68.

  3. 3.

    Gonzalez R, Nelson LG, Gallagher SF et al. Anastomotic leaks after laparoscopic gastric bypass. Obes Surg 2004; 14: 1299–307.

  4. 4.

    Fernandez AZ Jr, DeMaria EJ, Tichansky DS et al. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc 2004; 18: 193–7.

  5. 5.

    Byrne TK. Complications of surgery for obesity. Surg Clin North Am 2001; 81: 1181–93.

  6. 6.

    Brolin RE. Gastric bypass. Surg Clin North Am 2001; 81: 1077–95.

  7. 7.

    Gorecki P, Wise L, Brolin RE et al. Complications of combined gastric restrictive and malabsorptive procedures: Part 1. Curr Surg 2003; 60: 138–44.

  8. 8.

    McLachlin AD, Denton DW. Omental protection of intestinal anastomoses. Am J Surg 1973; 125: 134––40.

  9. 9.

    Morrison R. Remarks on some functions of the omentum. Br Med J 1906; 1: 76–8.

  10. 10.

    Samson R, Pasternak BM. Current status of surgery of the omentum. Surg Gynecol Obstet 1979; 149: 437–42.

  11. 11.

    Graham RR: The treatment of perforated duodenal ulcers. Surg Gynec Obstet 1937; 64: 235–8.

  12. 12.

    Lanter B, Mason RA. Use of omental pedicle graft to protect low anterior colonic anastomosis. Dis Colon Rectum 1979; 22: 448–51.

  13. 13.

    Tocchi A, Mazzoni G, Lepre L et al. Prospective evaluation of omentoplasty in preventing leakage of colorectal anastomosis. Dis Colon Rectum 2000; 43: 951–5.

Download references

Author information

Correspondence to Ollie Jackson MD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Saber, A.A., Jackson, O. Omental Wrap: A Simple Technique for Reinforcement of the Gastrojejunostomy during Roux-en-Y Gastric Bypass. OBES SURG 17, 15 (2007). https://doi.org/10.1007/s11695-007-9000-y

Download citation

Key words

  • Morbid obesity
  • gastric bypass
  • omentum
  • anastomosis
  • Roux-en-Y