Introduction: The current gold standard for surgical management of morbid obesity is the laparoscopic roux-en-Y gastric bypass (LRYGB). In this video, we describe a modification of the technique called the "UCLA U-Loop," which has the benefit of maintaining visuospatial orientation by keeping both anastomoses in the left epigastrium. The technique offers the potential to reduce steps, facilitate stapling, and avoid anatomical confusion. The surgeon and assistant are positioned ergonomically, and the procedure can be performed expeditiously.

Methods: Between 2003 and 2007, 1096 U-loop cases were performed at our institution. A prospective database was maintained; data includes: patient demographics, comorbidities, peri-operative events, complications and follow-up information.

Results: Thirty-day complications included: bleeding (4.4%), pneumonia (1%), obstruction (0.9%), perforation (0.3%), cardiac events (0.3%), and pulmonary embolus (0.001%). There were no leaks, strictures or deaths. Late complications included: perforation (1.4%), ulcer (1.3%), obstruction (0.6%), bleeding (0.2%), pulmonary embolus (0.001%), and death (0.2%). There were no strictures. Average excess body weight loss was 63% and 62% at one and two years, respectively, and the majority of patients experienced improvement or resolution of their obesity-related comorbidities.

Conclusion: The UCLA U-Loop technique facilitates visuospatial orientation by allowing for all steps to be performed comfortably by the surgeon in the same location. Isolating maneuvers in the left upper quadrant additionally enhances the ease of performing the procedure with robotic assistance. Review of our experience demonstrates that it is a safe, effective and simpler alternative to other techniques of LRYGB.