Gastrotomy with anvil "dunk": a novel technique for gastrojejunostomy in the patient undergoing laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Many techniques for performing the gastrojejunostomy required in the laparoscopic roux-en-Y gastric bypass (LRYGB) have been described. The current study presents the results of a previously unreported method. METHODS: A total of 21 patients (2 men and 19 women) with morbid obesity underwent LRYGB over a period of 5 months. The gastrojejunostomy was created by performing a gastric transection to form a 20- to 30-ml pouch using a linear stapler. This was followed by gastrotomy using an ultrasonic scalpel along the anterior surface of the pouch. A purse-string suture then was placed circumferentially using standard laparoscopic intracorporeal suturing with an Endo-stitch device. Finally, a 25-mm circular stapler anvil was placed within the abdomen via the 15-mm left lower quadrant port site. The shaft of the anvil was grasped; the head of the anvil was "dunked" into the gastrotomy; and the purse-string suture was tied intracorporeally. RESULTS: A total of 21 patients have undergone LRYGB at the authors' institution using this technique. The early results have been excellent in all cases, with no leaks, no strictures, and no obstructions. CONCLUSION: Gastrotomy with anvil dunk is a reproducible and safe method for constructing the gastrojejunostomy. It is an advanced laparoscopic technique that closely resembles open surgical techniques and provides a safe alternative to existing methods.