A novel approach for Roux limb construction via the lesser sac

Area of Science:

• Minimally Invasive Surgery
• Bariatric Surgery Techniques
• Surgical Anatomy

Background:

• Laparoscopic gastric bypass requires exposure of the ligament of Treitz for Roux limb construction.
• Omental manipulation (division or displacement) is often necessary, which can be compromised by factors like bulky omentum, hepatomegaly, adhesions, or obesity.
• Difficulties in accessing the inframesocolic abdomen necessitate alternative surgical strategies.

Observation:

• The lesser sac approach provides an alternative route for Roux limb construction.
• This technique involves entering the lesser sac through the gastrocolic ligament.
• The transverse mesocolon is opened to identify the ligament of Treitz, allowing jejunal manipulation.

Findings:

• The jejunum is brought into the lesser sac for Roux limb construction.
• The jejunojejunostomy is then repositioned into the inframesocolic compartment.
• Mesenteric defects are closed, and the gastric bypass procedure is completed.

Implications:

• This method offers a viable alternative for laparoscopic gastric bypass when standard exposure is compromised.
• It may reduce the need for more extensive surgical interventions in complex cases.
• The lesser sac approach enhances the versatility of laparoscopic bariatric surgery.