Roux-en-Y gastric bypass is the most common bariatric procedure performed in the United States. However, anastomotic leak and bleeding are potential complications following that procedure. The most common site for anastomotic leak and bleeding is the gastrojejunostomy. We herein describe our technique for dual reinforcement of the gastrojejunal anastomosis during laparoscopic gastric bypass.

A 20 ml vertically oriented gastric pouch, based on the lesser curvature of the stomach is created. The greater omentum is divided vertically. The jejunum is divided 50 cm beyond the ligament of Treitz. The Roux limb is then brought up between the two halves of the omentum in an antecolic antegastric fashion to verify its reach to the gastric pouch without tension. Gastrojejunostomy is created using a 45 mm endo GIA stapler with intraluminal reinforcement using bioabsorbable le-line reinforcement materials. The gastrojejunal anastomosis is reinforced extraluminally with an omental wrap (omental flap). The jejunojejunostomy is created 100-150 cm from the gastrojejunostomy.

During gastric bypass, dual reinforcement of the gastrojejunostomy is a simple, feasible, and protective adjunctive maneuver that can minimize the risk of gastrojejunal leak and bleeding.