Laparoscopic roux-en-y gastric bypass: Principles and procedures

Obesity has reached epidemic proportions in the pediatric and adolescent populations. As the safety and efficacy of bariatric surgery for adults has become evident, more attention has been given to consideration of bariatric surgical interventions for clinically severely obese adolescents (Inge et al. 2004a). Minimally invasive procedures have been developed for all of the modern weight-loss procedures including the Roux-en-Y gastric bypass (RYGBP), the adjustable gastric band, the vertical banded gastroplasty (OBrien et al. 1999; Schirmer 2000), and the biliopancreatic diversion with duodenal switch. The RYGBP has been used most widely in the USA because of its safe side effect profile, balanced with excellent long-term weight loss and maintenance (Pories et al. 1995). RYGBP effectively allows adolescents to lose one third or more of excess body weight and improves or cures most comorbidities of obesity (Inge et al. 2004b; Sugerman et al. 2003). Minimally invasive bariatric surgery is one of the most technically difficult operations to perform. Laparoscopic skills utilized in foregut surgery are not directly transferable to bariatric surgery. Expertise in minimally invasive surgery may not confer the same level of expertise in performing minimally invasive bariatric surgery. Adequate technical training is critical prior to embarking on minimally invasive surgical treatment for adolescent severe obesity and, at a minimum, should include taking an accredited course of study in bariatric surgery (www.asmbs.org; www.sages. org) and performing procedures first proctored by an experienced laparoscopic bariatric surgeon.