Hand-assisted laparoscopic bariatric surgery

Bariatric surgery implies a major life-long rearrangement of the gastrointestinal tract to obtain a controlled weight reduction in a severe but nonmalignant disease. Obesity poses a special challenge to the laparoscopic surgeon. Laparoscopy is known to facilitate the perioperative phase for the patient, but is technically difficult to perform in morbidly obese subjects. Hand-assistance adds extra control in demanding procedures, and Hand-port systems for use in the thick abdominal wall are now available. Here we review the role of hand-assisted laparoscopy for common bariatric procedures and describe our technique for Hand-assisted laparoscopic Roux-en-Y Gastric bypass. Hand-assistance might be the well-blended mix for complex laparoscopic procedures in bariatric work, especially for surgeons working outside highly specialized laparoscopic centers.