Functional Laparoscopic Roux-en-Y Gastric Bypass with Fundectomy and Gastric Remnant Exploration (LRYGBfse)-a Video Vignette

Background The laparoscopic Roux en-Y gastric bypass (LRYGB) is performed worldwide and is considered by many the gold standard treatment for morbid obesity. However, the difficult access to the gastric remnant and duodenum represents intrinsic limitations. The functional laparoscopic gastric bypass with fundectomy and gastric remnant exploration (LRYGBfse) is a new technique described in attempt to overcome the limitations of the LRYGB. The purpose of this video was to demonstrate the LRYGBfse in a 48-year-old man with type II diabetes and hypertension. Methods An intraoperative video has been anonymized and edited to demonstrate the feasibility of LRYGBfse. Results The operation started with the opening of the gastrocolic ligament. Staying close to the gastric wall, the stomach is prepared up to the angle of His. After the placement of a 36-Fr orogastric probe, gastric fundectomy is completed in order to create a 30cc gastric pouch. A polytetrafluoroethylene banding (ePTFE) is placed at the gastro-gastric communication, 7cm below the cardia, and gently closed after bougie retraction. The bypass is completed by the creation of an antecolic Roux-en-Y 150cm alimentary and 150cm biliopancreatic limb. Conclusion The LRYGBfse is a feasible and safe technique. The possibility to endoscopically explore the excluded stomach with an easy access to the Vater's papilla is a major advantage. Further studies are warranted to deeply explore and compare outcomes with the standard LRYGB.