Skip to main content
Log in

Transoral Technique for Gastrojejunostomy in Laparoscopic Roux-en-Y Gastric Bypass (LRYGBP) Can Accelerate Learning Curve and Reduce Cost

  • Research Article
  • Published:
Obesity Surgery Aims and scope Submit manuscript



The stapled gastrojejunostomy of the laparoscopic Roux-en-Y gastric bypass (LRYGBP) can be created by linear and circular stapling techniques. In the circular-stapled technique, the anvil of the stapler can be introduced into the gastric pouch transabdominally or pulled down the esophagus (transorally) by attachment to a modified gastric tube. The purpose of this study is to determine if the transoral technique to introduce the anvil will reduce operative time and cost compared with the transabdominal technique, which requires creating a new gastrotomy to insert the anvil and followed by its closure.


We compared 60 consecutive morbidly obese patients who underwent laparoscopic RYGBP. First 30 cases were performed by transabdominal anvil insertion, followed by 30 cases using transoral anvil insertion. All of the transabdominal cases were assisted by experienced fellows. The first ten transoral cases were assisted by experienced fellows and the remaining 20 by new fellows in order to evaluate if the transoral technique shortens the learning curve. Surgery duration and operative costs were compared. Complications (bleeding, leaks, anastomotic strictures, ulcers, wound infections) and length of stay were also evaluated. Data are expressed as mean ± SD.


Mean operative time was shorter in the transoral group compared with the transabdominal group (162.2 ± 35.8 vs. 186 ± 33.6 min respectively, p = 0.01), even though most of the transoral cases (n = 20) were assisted by new fellows and all of the transabdominal cases by experienced fellows. Operative times were not different between new and experienced fellows in the transoral technique. Supply costs per patient were higher in the transabdominal technique compared with the transoral technique (2,983.5 ± 540.9 vs. 2,658.8 ± 474.4 USD, respectively, p = 0.03). Perioperative complications and length of stay were not statistically different.


The transoral introduction of the anvil of the circular stapler into the gastric pouch is a simple, safe, and efficient technique for creating the gastrojejunostomy in laparoscopic RYGBP. In addition, the transoral technique is less expensive and appears to accelerate the learning curve compared with the transabdominal technique.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others


  1. Wright JD, Borrud LG, McDowell MA, et al. Nutrition assessment in the National Health And Nutrition Examination Survey 1999–2002. J Am Diet Assoc 2007;107:822–9.

    Article  PubMed  Google Scholar 

  2. Smith SC Jr, Clark LT, Cooper RS, et al. Discovering the full spectrum of cardiovascular disease: Minority Health Summit 2003: report of the Obesity, Metabolic Syndrome, and Hypertension Writing Group. Circulation 2005;111:e134–9.

    Article  PubMed  Google Scholar 

  3. McGrath V, Needleman BJ, Melvin WS. Evolution of the laparoscopic gastric bypass. J Laparoendosc Adv Surg Tech A 2003;13:221–7.

    Article  PubMed  Google Scholar 

  4. Long DA, Reed R, Lehman G. The cost of lifestyle health risks: obesity. J Occup Environ Med 2006;48:244–51.

    Article  PubMed  Google Scholar 

  5. Matthews BD, Sing RF, DeLegge MH, et al. Initial results with a stapled gastrojejunostomy for the laparoscopic isolated roux-en-Y gastric bypass. Am J Surg 2000;179:476–81.

    Article  CAS  PubMed  Google Scholar 

  6. Gentileschi P, Kini S, Catarci M, et al. Evidence-based medicine: open and laparoscopic bariatric surgery. Surg Endosc 2002;16:736–44.

    Article  CAS  PubMed  Google Scholar 

  7. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995;222:339–50, discussion 350–2.

    Article  CAS  PubMed  Google Scholar 

  8. Cottam DR, Mattar SG, Schauer PR. Laparoscopic era of operations for morbid obesity. Arch Surg 2003;138:367–75.

    Article  PubMed  Google Scholar 

  9. Schauer PR, Ikramuddin S. Laparoscopic surgery for morbid obesity. Surg Clin North Am 2001;81:1145–79.

    Article  CAS  PubMed  Google Scholar 

  10. Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000;232:515–29.

    Article  CAS  PubMed  Google Scholar 

  11. Schauer PR. Open and laparoscopic surgical modalities for the management of obesity. J Gastrointest Surg 2003;7:468–75.

    Article  PubMed  Google Scholar 

  12. Blachar A, Federle MP, Pealer KM, et al. Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology 2002;223:625–32.

    Article  PubMed  Google Scholar 

  13. Gonzalez R, Lin E, Venkatesh KR, et al. Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques. Arch Surg 2003;138:181–4.

    Article  PubMed  Google Scholar 

  14. Peters MB Jr, Ojeda HF, Reichenbach DJ, et al. Gastrotomy with anvil “dunk”: a novel technique for gastrojejunostomy in the patient undergoing laparoscopic Roux-en-Y gastric bypass. Surg Endosc 2006;20:924–8.

    Article  PubMed  Google Scholar 

  15. Murr MM, Gallagher SF. Technical considerations for transabdominal loading of the circular stapler in laparoscopic Roux-en-Y gastric bypass. Am J Surg 2003;185:585–8.

    Article  PubMed  Google Scholar 

  16. Teixeira JA, Borao FJ, Thomas TA, et al. An alternative technique for creating the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass: experience with 28 consecutive patients. Obes Surg 2000;10:240–4.

    Article  CAS  PubMed  Google Scholar 

  17. Wittgrove AC, Clark GW, Schubert KR. Laparoscopic gastric bypass, Roux-en-Y: technique and results in 75 patients with 3–30 months follow-up. Obes Surg 1996;6:500–4.

    Article  PubMed  Google Scholar 

  18. Scott DJ, Provost DA, Jones DB. Laparoscopic Roux-en-Y gastric bypass: transoral or transgastric anvil placement? Obes Surg 2000;10:361–5.

    Article  CAS  PubMed  Google Scholar 

  19. Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y-500 patients: technique and results, with 3–60 month follow-up. Obes Surg 2000;10:233–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Luis Felipe Chavarriaga.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chavarriaga, L.F., Cook, M.W., White, B. et al. Transoral Technique for Gastrojejunostomy in Laparoscopic Roux-en-Y Gastric Bypass (LRYGBP) Can Accelerate Learning Curve and Reduce Cost. OBES SURG 20, 846–850 (2010).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: