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The Conventional Gastric Bypass

  • Chapter
Principles of Metabolic Surgery

Abstract

After the Second World War during the 1950's, subtotal gastrectomy with the Billroth II reconstruction was the surgical treatment of choice for peptic ulcer disease. Post-operative weight loss and early satiety were frequently observed in these patients, and these observations led Mason in 1966 to begin restrictive bariatric surgery by introducing the gastric bypass procedure. The initial technique involved a horizontal proximal gastric division of 10% of the stomach with a gastric pouch of approximately 100–150 ml. Mason reconstructed the alimentary passage with a short afferent biliopancreatic limb and a 12-mm in diameter end-side gastrojejunal anastomosis, and then left the residual distal stomach in place. Later on, Mason improved early satiety and postoperative weight loss by reducing the gastric pouch to 50 ml. Further improvements and modifications were made by Ward Griffen, who introduced the retrocolic Roux-en-Y loop reconstruction. He excluded the biliopancreatic juices and thereby reduced the risk of gastrojejunal fistulas. Griffen and Alden modified this technique with a simple division of the stomach without performing a complete transection. Jose Torres and Clemente Oca introduced the prototype of the modern gastric bypass procedure. They created the gastric pouch on the lesser curvature, 4 cm distal to the cardia, and separated the gastric pouch from the rest of the stomach. They created a gastric pouch with 35 ml volume. The jejunum was dissected 45 cm from the ligament of Treitz, and the gastroentero-anastomosis (GEA) was performed with a 21-mm circular stapler, with the anvil inserted through a gastrostomy in the upper part of the anterior wall of the pouch. The end-loop with the end-side anastomosis was created at 90 cm. The first laparoscopic gastric bypass was performed by Wittgrove in 1994. Later, several technical variations were introduced with sometimes mechanical, sometimes manual, gastroenteroanastomosis. The stomach is always transected, and the gastric pouch is usually vertical and on the lesser gastric curvature. The alimentary, common, and biliopancreatic limbs are of variable length and depend on the intention to enhance either the restrictive or the malabsorptive potency of the procedure.

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  1. Oliver Thomusch MD
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  2. W. Konrad Karcz MD
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  1. Abt. Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg

    W. Konrad Karcz  & Oliver Thomusch  & 

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Thomusch, O., Karcz, W.K. (2012). The Conventional Gastric Bypass. In: Karcz, W.K., Thomusch, O. (eds) Principles of Metabolic Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-02411-5_19

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