roux en y anastomosis


Summary: A Y-shaped surgical anastomosis of any part of the digestive system which includes the small intestine as the eventual drainage site.

Top Publications

  1. Blachar A, Federle M, Pealer K, Ikramuddin S, Schauer P. Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology. 2002;223:625-32 pubmed
    ..Upper GI complications that required intervention occurred in 9.5% of patients. CT and upper GI series can depict most major complications. ..
  2. Livingston E. Obesity and its surgical management. Am J Surg. 2002;184:103-13 pubmed
    ..Following weight loss there is a high cure rate for diabetes and sleep apnea, with significant improvement in other complications of obesity such as hypertension and osteoarthritis. ..
  3. Schauer P, Ikramuddin S, Hamad G, Gourash W. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc. 2003;17:212-5 pubmed
    ..LGB is a technically challenging operation with a long learning curve. To minimize morbidity related to the learning curve, strategies for developing training programs must address these challenges. ..
  4. Andrew C, Hanna W, Look D, McLean A, Christou N. Early results after laparoscopic Roux-en-Y gastric bypass: effect of the learning curve. Can J Surg. 2006;49:417-21 pubmed
    ..LRYGB can be performed with acceptable morbidity and short-term results during the learning curve. In our series, operative time and anastomotic stricture rates decreased with experience, despite an increase in mean BMI. ..
  5. Blackstone R, Rivera L. Predicting stricture in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass: a logistic regression analysis. J Gastrointest Surg. 2007;11:403-9 pubmed
    ..Gastroesophageal reflux disease and age were each shown to be statistically significant independent predictors of stricture following laparoscopic gastric bypass. ..
  6. Peifer K, Shiels A, Azar R, Rivera R, Eagon J, Jonnalagadda S. Successful endoscopic management of gastrojejunal anastomotic strictures after Roux-en-Y gastric bypass. Gastrointest Endosc. 2007;66:248-52 pubmed
    ..Endoscopic balloon dilation is a safe and effective method for the management of gastrojejunostomy strictures after Roux-en-Y gastric bypass. Dilation to at least 15 mm is safe and decreases the need for further endoscopic dilation. ..
  7. Carrodeguas L, Szomstein S, Zundel N, Lo Menzo E, Rosenthal R. Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass surgery: analysis of 1291 patients. Surg Obes Relat Dis. 2006;2:92-7 pubmed
    ..Endoscopic balloon dilatation can be offered as a first-line treatment for gastrojejunal anastomotic strictures. Perforation is a potential complication of this treatment and may necessitate surgical intervention. ..
  8. Hope W, Zerey M, Schmelzer T, Newcomb W, Paton B, Heath J, et al. A comparison of gastrojejunal anastomoses with or without buttressing in a porcine model. Surg Endosc. 2009;23:800-7 pubmed publisher
    ..The long-term effect of BSG on anastomotic strength or scarring is yet to be determined. The clinical implications may include decreased stricture formation and also decreased strength at anastomoses. ..
  9. Jones W, Myers K, Traxler L, Bour E. Clinical results using bioabsorbable staple line reinforcement for circular staplers. Am Surg. 2008;74:462-7; discussion 467-8 pubmed
    ..On this basis, strong consideration should be given to the routine use of CBSG staple line reinforcement in patients undergoing laparoscopic divided gastric bypass with a circular stapled gastrojejunal anastomosis. ..

More Information


  1. Ukleja A, Afonso B, Pimentel R, Szomstein S, Rosenthal R. Outcome of endoscopic balloon dilation of strictures after laparoscopic gastric bypass. Surg Endosc. 2008;22:1746-50 pubmed publisher
    ..However, it carries a small risk of perforation. Further case studies are needed to determine risk factors for perforation and if the patients can be managed conservatively in this setting. ..
  2. Suggs W, Kouli W, Lupovici M, Chau W, Brolin R. Complications at gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass: comparison between 21- and 25-mm circular staplers. Surg Obes Relat Dis. 2007;3:508-14 pubmed
    ..2%) with the 21-mm and 39 (10.2%) with the 25-mm stapler. The rate of anastomotic stricture was significantly lower using the 25-mm circular stapler. ..
  3. Carter J, Tafreshian S, Campos G, Tiwari U, Herbella F, Cello J, et al. Routine upper GI series after gastric bypass does not reliably identify anastomotic leaks or predict stricture formation. Surg Endosc. 2007;21:2172-7 pubmed
    ..A selective approach, whereby imaging is reserved for patients with clinical evidence of a leak or stricture, may be more appropriate. ..
  4. Rossi T, Dynda D, Estes N, Marshall J. Stricture dilation after laparoscopic Roux-en-Y gastric bypass. Am J Surg. 2005;189:357-60 pubmed
    ..Endoscopic balloon dilation is a safe and effective treatment option for GJ stricture. Improved weight loss occurred for patients with stricture requiring dilation. ..
  5. Klaus A, Hinder R, Nguyen J, Nelson K. Small bowel transit and gastric emptying after biliodigestive anastomosis using the uncut jejunal loop. Am J Surg. 2003;186:747-51 pubmed
    ..The uncut proximal jejunum loop is a good alternative to the conventional Roux-en-Y loop and showed preserved small bowel motility and adequate jejunal transit. Gastric emptying is slowed in both groups. ..
  6. Dresel A, Kuhn J, McCarty T. Laparoscopic Roux-en-Y gastric bypass in morbidly obese and super morbidly obese patients. Am J Surg. 2004;187:230-2; discussion 232 pubmed
    ..Laparoscopic RYGB is safe and technically feasible in the super morbidly obese patient population. ..
  7. Nguyen N, Stevens C, Wolfe B. Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass. J Gastrointest Surg. 2003;7:997-1003; discussion 1003 pubmed
    ..Endoscopic balloon dilation is a safe and effective option in the management of anastomotic stricture following laparoscopic GBP. ..
  8. Bell R, Reinhardt K, Flowers J. Surgeon-performed endoscopic dilatation of symptomatic gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:728-33 pubmed
    ..The endpoint for stricture dilatation is 12 mm or slightly larger. The operating surgeon should acquire a working knowledge of these techniques. ..
  9. Demaria E, Sugerman H, Kellum J, Meador J, Wolfe L. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg. 2002;235:640-5; discussion 645-7 pubmed
    ..The learning curve is evident: operative time and leaks decreased with experience and improved techniques. The primary advantage is an extremely low risk of wound complications, including infection and hernia. ..
  10. Hashiguchi N, Kubota T, Otani Y, Yoshida M, Maeda S, Tokuyama J, et al. Surgery for advanced gastric cancer after coronary artery bypass grafting using the right gastroepiploic artery: report of a case. Surg Today. 2004;34:456-8 pubmed
    ..This case report serves to demonstrate that radical gastrectomy can be safely performed after CABG using the RGEA, and that gastric cancer will progress in spite of SSM therapy...
  11. Lyass S, Khalili T, Cunneen S, Fujita F, Otsuka K, Chopra R, et al. Radiological studies after laparoscopic Roux-en-Y gastric bypass: routine or selective?. Am Surg. 2004;70:918-21 pubmed
    ..High sensitivity makes CT the test of choice in patients with suspected complication after LRYGB. Routine radiological studies are not warranted. ..
  12. Cottam D, Mattar S, Schauer P. Laparoscopic era of operations for morbid obesity. Arch Surg. 2003;138:367-75 pubmed
  13. Luján J, Frutos M, Hernández Q, Cuenca J, Valero G, Parrilla P. Experience with the circular stapler for the gastrojejunostomy in laparoscopic gastric bypass (350 cases). Obes Surg. 2005;15:1096-102 pubmed
    ..The rate of complications has been low. Surgeons who perform laparoscopic RYGBP should have a careful learning curve, and should be aware of the potential complications and their management. ..
  14. Gentileschi P, Kini S, Catarci M, Gagner M. Evidence-based medicine: open and laparoscopic bariatric surgery. Surg Endosc. 2002;16:736-44 pubmed
    ..Laparoscopic biliopancreatic diversion with duodenal switch is feasible, but needs further studies. Randomized controlled trials comparing the various laparoscopic operations are strongly needed. ..
  15. Csendes A, Burdiles P, Braghetto I, Korn O, Diaz J, Rojas J. Early and late results of the acid suppression and duodenal diversion operation in patients with barrett's esophagus: analysis of 210 cases. World J Surg. 2002;26:566-76 pubmed
    ..This effect is permanent and avoids the appearance of dysplasia or adenocarcinoma. ..
  16. Inabnet W, Quinn T, Gagner M, Urban M, Pomp A. Laparoscopic Roux-en-Y gastric bypass in patients with BMI <50: a prospective randomized trial comparing short and long limb lengths. Obes Surg. 2005;15:51-7 pubmed
    ..In patients with BMI <50 undergoing LRYGBP, increasing the length of the Roux limb does not improve weight loss and may lead to a higher incidence of internal hernias. ..
  17. Fernandez A, DeMaria E, Tichansky D, Kellum J, Wolfe L, Meador J, et al. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc. 2004;18:193-7 pubmed
    ..The data suggests that older, heavier male patients with multiple comorbid conditions are at increased risk for leak and mortality. Surgeons early in their learning curve should avoid these high-risk patients to reduce complications. ..
  18. Perugini R, Mason R, Czerniach D, Novitsky Y, Baker S, Litwin D, et al. Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients. Arch Surg. 2003;138:541-5; discussion 545-6 pubmed
    ..06). Surgeon experience, sleep apnea, and hypertension are associated with complications after laparoscopic RYGB. Diabetes mellitus may be associated with poorer postoperative weight loss. ..
  19. Livingston E, Ko C. Assessing the relative contribution of individual risk factors on surgical outcome for gastric bypass surgery: a baseline probability analysis. J Surg Res. 2002;105:48-52 pubmed
    ..These factors increased the predicted complication rate by 56, 67, 28 and 28%, respectively. ..
  20. Gonzalez R, Lin E, Venkatesh K, Bowers S, Smith C. Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques. Arch Surg. 2003;138:181-4 pubmed
    ..However, these differences may reflect the learning curve because these techniques were used early in our experience. Lower postoperative stricture and wound infection rates seem to be the primary benefits of the HSA technique. ..
  21. Khaitan L, Van Sickle K, Gonzalez R, Lin E, Ramshaw B, Smith C. Laparoscopic revision of bariatric procedures: is it feasible?. Am Surg. 2005;71:6-10; discussion 10-2 pubmed
    ..Revisional bariatric surgery can be approached laparoscopically and with acceptable morbidity comparable to patients whose revision is approached open. ..
  22. Moro L, Cazzani C, Tomarchio O, Morone G, Catona A, Fantinato D. Patient dose during radiological examination in the follow-up of bariatric surgery. Radiat Prot Dosimetry. 2007;123:113-7 pubmed
    ..5 and 2.7 mSv. The organs receiving the highest doses were not only breast, stomach, pancreas and liver, but also lungs, owing to of their high radiosensitivity, significantly contributed to the effective dose. ..
  23. Amitha Vikrama K, Keshava S, Surendrababu N, Moses V, Joseph P, Vyas F, et al. Jejunal access loop cholangiogram and intervention using image guided access. J Med Imaging Radiat Oncol. 2010;54:5-8 pubmed publisher
    ..Access loop cholangiogram and interventions are safe and effective. CT guidance in locating/procuring the access loop is a good technique...
  24. Miller K, Pump A. Use of bioabsorbable staple reinforcement material in gastric bypass: a prospective randomized clinical trial. Surg Obes Relat Dis. 2007;3:417-21; discussion 422 pubmed
    ..No adverse events related to the resorbable buttressing material were observed. ..
  25. Bennett J, Wang H, Schirmer B, Northup C. Quality of life and resolution of co-morbidities in super-obese patients remaining morbidly obese after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3:387-91 pubmed
    ..Super-obese patients experience significant improvements in co-morbidities and quality of life after Roux-en-Y gastric bypass even if their BMI remains >35 kg/m(2). ..
  26. Tanaka H, Fukuda A, Shigeta T, Kuroda T, Kimura T, Sakamoto S, et al. Biliary reconstruction in pediatric live donor liver transplantation: duct-to-duct or Roux-en-Y hepaticojejunostomy. J Pediatr Surg. 2010;45:1668-75 pubmed publisher
    ..Roux-en-Y hepaticojejunostomy seems preferable to DD in the setting of pediatric LDLT, but DD must be considered when making new Roux-en-Y limb seems impossible or troublesome owing to abdominal dense adhesion or short bowel syndrome. ..
  27. Kazemi A, Frazier T, Cave M. Micronutrient-related neurologic complications following bariatric surgery. Curr Gastroenterol Rep. 2010;12:288-95 pubmed publisher
    ..Clinical symptoms range from peripheral neuropathy to encephalopathy, and are most commonly caused by thiamine, copper, and B(12) deficiencies. ..
  28. Diao M, Li L, Zhang J, Cheng W. A shorter loop in Roux-Y hepatojejunostomy reconstruction for choledochal cysts is equally effective: preliminary results of a prospective randomized study. J Pediatr Surg. 2010;45:845-7 pubmed publisher
    ..No episodes of cholangitis were observed in either group. An individualized short Roux-loop length in RYHJ is as effective as the conventional Roux-loop length. ..
  29. Aydin U, Yazici P, Yuksekkaya H, Arikan C, Aydogdu S, Zeytunlu M, et al. Timing of Roux-en-Y limb reconstruction for pediatric live donor liver transplantation. Transplantation. 2008;85:1431-5 pubmed publisher
    ..This approach can be helpful to avoid gastrointestinal complications due to the reconstruction of the R-Y limb. ..
  30. Gonzalez R, Haines K, Nelson L, Gallagher S, Murr M. Predictive factors of thromboembolic events in patients undergoing Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006;2:30-5; discussion 35-6 pubmed
    ..Further preoperative screening and/or postoperative prophylaxis may be needed in this subset of high-risk patients. ..
  31. Ahlawat S, Fishbein T, Al Kawas F. Extracorporeal shockwave lithotripsy for renal calculi: an unusual cause of common bile duct stricture. Endoscopy. 2007;39 Suppl 1:E32-3 pubmed
  32. Sanchez C, Brody F, Pucci E, Bashir S. Laparoscopic total gastrectomy for Ménétrier's disease. J Laparoendosc Adv Surg Tech A. 2007;17:32-5 pubmed
    ..Ménétrier's disease is a rare gastrointestinal entity that can be treated safely with minimally invasive skills. We report this case in detail and discuss Ménétrier's disease. ..
  33. Wayne M, Jorge I, Cooperman A. Alternative reconstruction after pancreaticoduodenectomy. World J Surg Oncol. 2008;6:9 pubmed publisher
    ..In addition, it has the added benefit of eliminating bile reflux gastritis. Future randomized control trials are recommended to further evaluate the efficacy of the procedure. ..
  34. Berindoague R, Targarona E, Feliu X, Artigas V, Balague C, Aldeano A, et al. Laparoscopic resection of clinically suspected gastric stromal tumors. Surg Innov. 2006;13:231-7 pubmed
    ..The laparoscopic approach to surgical treatment of these tumors seems safe and is associated with acceptable intermediate-term results, especially in cases of gastrointestinal stromal tumors. ..
  35. Baltasar A. Laparoscopic conversion from Roux-en-Y gastric bypass to biliopancreatic diversion/duodenal switch. Surg Obes Relat Dis. 2008;4:210; author reply 210-1 pubmed publisher
  36. Goergen M, Arapis K, Limgba A, Schiltz M, Lens V, Azagra J. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic vertical banded gastroplasty: results of a 2-year follow-up study. Surg Endosc. 2007;21:659-64 pubmed
    ..The patient's eating habits before surgery play an important role in the choice of the operative technique used. ..
  37. McAllister M, Donoway T, Lucktong T. Synchronous intussusceptions following Roux-en-Y Gastric Bypass: case report and review of the literature. Obes Surg. 2009;19:1719-23 pubmed publisher
    ..Awareness of the potential for this process and prompt consultation with a bariatric surgeon are keys to optimal outcomes. ..
  38. Jeong O, Park Y. Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc. 2009;23:2624-30 pubmed publisher
    ..We believe that our procedure is a secure and reliable reconstruction method after LTG, which is especially useful in obese patients, in whom conventional extracorporeal anastomosis often is difficult. ..
  39. Sakamoto Y, Kajiwara T, Esaki M, Shimada K, Nara S, Kosuge T. Roux-en-Y reconstruction using staplers during pancreaticoduodenectomy: results of a prospective preliminary study. Surg Today. 2009;39:32-7 pubmed publisher
    ..Our retrospective analysis shows that stapled reconstructions might reduce the incidence of delayed gastric emptying; however, further study will be necessary to evaluate the utility of this new method. ..
  40. Shimamura K, Otani T, Yamazaki T, Kuwabara S, Katayanagi N, Yamamoto M, et al. Jejunal loop obstruction by a gallstone from hepaticojejunostomy-induced acute cholangitis: report of a case. Surg Today. 2006;36:737-40 pubmed
    ..As with other major complications, early diagnosis and prompt initiation of surgical treatment are important to prevent any deterioration in the patient's general condition. ..
  41. Lopes T, Wilcox C. Endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y anatomy. Gastroenterol Clin North Am. 2010;39:99-107 pubmed publisher
  42. Taylor J, Ryckman F. Management of small bowel volvulus around feeding Roux-en-Y limbs. Pediatr Surg Int. 2010;26:439-42 pubmed publisher
    ..No predictors of volvulus were identified. Once revised, no recurrences were observed. While this complication is uncommon, it has potentially catastrophic outcomes requiring early intervention. ..
  43. Noshiro H, Ohuchida K, Kawamoto M, Ishikawa M, Uchiyama A, Shimizu S, et al. Intraabdominal Roux-en-Y reconstruction with a novel stapling technique after laparoscopic distal gastrectomy. Gastric Cancer. 2009;12:164-9 pubmed publisher
    ..Oral intake was easy and adequate after surgery. The present Roux-en-Y reconstruction procedure is feasible. Herein we describe an intraabdominal Roux-en-Y reconstruction with a modified stapling technique after LDG. ..
  44. Huang C, Houng J, Chiang C, Chen Y, Lee P. Single incision transumbilical laparoscopic Roux-en-Y gastric bypass: a first case report. Obes Surg. 2009;19:1711-5 pubmed publisher
    ..When performed via the transumbilical route, it can make the abdominal wound scarless and cosmetically more acceptable...
  45. Raval M, Phillips J. Optimal enteral feeding in children with gastric dysfunction: surgical jejunostomy vs image-guided gastrojejunal tube placement. J Pediatr Surg. 2006;41:1679-82 pubmed
    ..Although initially more invasive than IGJ, SJ may provide more stable feeding access with fewer complications. This represents the first published report comparing long-term outcomes between IGJ and SJ. ..
  46. Doraiswamy A, Rasmussen J, Pierce J, Fuller W, Ali M. The utility of routine postoperative upper GI series following laparoscopic gastric bypass. Surg Endosc. 2007;21:2159-62 pubmed
    ..We advocate selective UGI imaging following LRYGBP based on the patient's clinical factors, particularly fever and tachycardia. ..
  47. D Journo X, Martin J, Gaboury L, Ferraro P, Duranceau A. Roux-en-Y diversion for intractable reflux after esophagectomy. Ann Thorac Surg. 2008;86:1646-52 pubmed publisher
    ..Reflux symptoms are corrected and the mucosa is allowed to heal. The surgical approach is influenced by the position of the gastric transplant. Protection of the vascular supply to the gastric tube is the challenge of the operation. ..
  48. Schweitzer M, Lidor A, Magnuson T. A zero leak rate in 251 consecutive laparoscopic gastric bypass operations using a two-layer gastrojejunostomy technique. J Laparoendosc Adv Surg Tech A. 2006;16:83-7 pubmed
    ..The two-layer gastrojejunostomy anastomotic technique combines an inner stapled layer and outer sutured layer that yields excellent results. ..
  49. Pratt J, Van Noord M, Christison Lagay E. The tethered bezoar as a delayed complication of laparoscopic Roux-en-Y gastric bypass: a case report. J Gastrointest Surg. 2007;11:690-2 pubmed
    ..We include endoscopic images of the bezoar, a review of the related gastric bypass literature, and describe the changes made in our practice as a result of this complication...
  50. Houben C, Chan M, Cheung G, Lee K, Tam P, Yeung C. A hepaticojejunostomy: technical errors with 'twists and turns'. Pediatr Surg Int. 2006;22:841-4 pubmed
    ..Conventional imaging modalities failed to identify the pathology. Only a contrast enhanced CT scan supported by image rendering software allowed for the visualization of the underlying chronic obstruction of part of the mesentery. ..
  51. Bonvini R, Roffi M. [Endovascular treatment of below the knee arteries in critical limb ischemia]. Rev Med Suisse. 2010;6:1146-8, 1150-3 pubmed
    ..In many centers, this minimally invasive approach has become the treatment of choice for the majority of patients with CLI. This review illustrates the different techniques and the data for infra-popliteal endovascular interventions. ..
  52. Wei H, Wei B, Zheng Z, Zheng F, Qiu W, Guo W, et al. [Comparative study on three types of digestive reconstruction after total gastrectomy]. Zhonghua Wei Chang Wai Ke Za Zhi. 2006;9:301-4 pubmed
  53. Lanteri R, Rapisarda C, Santangelo M, Racalbuto A, Di Cataldo A, Licata A. Anastomotic dehiscence after gastrectomy for cancer. Personal series. Hepatogastroenterology. 2007;54:617-9 pubmed
    ..We observed a statistically significant decrease of leaks in the third period of our study. These data demonstrate a significant decrease of anastomotic leaks with stapler in comparison to manual anastomoses. ..