Chinese standardized surgical guideline for symmetric three-port laparoscopic Roux-en-Y gastric bypass (2023 edition)_West China Medical Journal

Authors：

 Obesity and Diabetes Active Health Professional Committee of China Association for Promotion of Health Science and Technology

Corresponding?author：

Obesity and Diabetes Active Health Professional Committee of China Association for Promotion of Health Science and Technology, Email: Huyangxi2046@163.com

Keywords：

Symmetric three-port laparoscopic Roux-en-Y gastric bypass; obesity; type 2 diabetes; surgical procedures; guideline

DOI：

10.7507/1002-0179.202309131

Video：

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A lot of evidence-based medical evidence has shown that laparoscopic Roux-en-Y gastric bypass (LRYGB) is a durable and effective method for obesity and diabetes, and can significantly improve a series of obesity-related metabolic complications. This guideline provides a detailed description of the main operating steps and technical points of the symmetric three-port LRYGB, including posture layout, trocar position selection, liver suspension, gauze exposure, production of small gastric sacs, gastrojejunal anastomosis and production of biliary pancreatic branches, entero-enteric side to side anastomosis, closure of gastrointestinal anastomosis and mesenteric hiatus, greater omentum coverage, and closure of incisions. The purpose is to standardize the operating process of the symmetrical three hole method of LRYGB, providing standardized surgical operation references for clinical doctors in the field of obesity metabolic surgery.

Citation： Obesity and Diabetes Active Health Professional Committee of China Association for Promotion of Health Science and Technology. Chinese standardized surgical guideline for symmetric three-port laparoscopic Roux-en-Y gastric bypass (2023 edition). West China Medical Journal, 2023, 38(12): 1792-1800. doi: 10.7507/1002-0179.202309131 Copy

1.	Mason EE, Ito C. Gastric bypass in obesity. Surg Clin North Am, 1967, 47(6): 1345-1351.
2.	Griffen WO Jr, Young VL, Stevenson CC. A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity. Ann Surg, 1977, 186(4): 500-509.
3.	Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg, 1994, 4(4): 353-357.
4.	Sandoval DA, Patti ME. Glucose metabolism after bariatric surgery: implications for T2DM remission and hypoglycaemia. Nat Rev Endocrinol, 2023, 19(3): 164-176.
5.	Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med, 2017, 376(7): 641-651.
6.	Courcoulas AP, King WC, Belle SH, et al. Seven-year weight trajectories and health outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) study. JAMA Surg, 2018, 153(5): 427-434.
7.	Sj?str?m L. Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med, 2013, 273(3): 219-234.
8.	Arterburn DE, Telem DA, Kushner RF, et al. Benefits and risks of bariatric surgery in adults: a review. JAMA, 2020, 24(9): 879-887.
9.	Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery survey 2018: similarities and disparities among the 5 IFSO chapters. Obes Surg, 2021, 31(5): 1937-1948.
10.	中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會, 中國肥胖代謝外科研究協作組. 中國肥胖代謝外科數據庫: 2022 年度報告. 中華肥胖與代謝病電子雜, 2023, 9(2): 83-91.
11.	中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 腹腔鏡 Roux-en-Y 胃旁路術規范化手術操作指南(2019 版). 中華肥胖與代謝病電子雜志, 2019, 5(2): 63-69.
12.	楊熠, 陳文輝, 董志勇, 等. 精準肥胖代謝外科理念在腹腔鏡 Roux-en-Y 胃旁路術中的應用. 中華胃腸外科雜志, 2022, 25(10): 875-880.
13.	高磊, 胡揚喜, 胡德升, 等. 對稱 3 孔法腹腔鏡袖狀胃切除術的臨床應用價值. 中華消化外科雜志, 2019, 18(9): 854-858.
14.	劉洋, 劉歡妹, 魏丹, 等. 三孔法腹腔鏡胃袖狀切除術治療肥胖癥的臨床療效. 中華消化外科雜志, 2017, 16(6): 566-570.
15.	董星, 胡揚喜, 李英, 等. 三孔法腹腔鏡胃袖狀切除術治療極重度肥胖合并心肌病的應用體會. 腹腔鏡外科雜志, 2021, 26(7): 256-259.
16.	牛牧天, 孟化, 胡揚喜, 等. 對稱三孔法腹腔鏡袖狀胃切除術治療原發性高血壓的療效分析. 腹腔鏡外科雜志, 2022, 27(2): 90-95.
17.	紀浩洋, 劉宇萌, 張潔, 等. 對稱三孔法腹腔鏡袖狀胃切除術治療 2 型糖尿病的療效分析. 中華普通外科雜志, 2020, 35(7): 569-570.
18.	Zhou B, Cao X, Wang Z, et al. Symmetric three-port laparoscopic Roux-en-Y gastric bypass: a novel technique that is safe, effective, and feasible. Surg Today, 2023, 53(6): 702-708.
19.	中華醫學會外科學分會甲狀腺及代謝外科學組, 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 中國肥胖及 2 型糖尿病外科治療指南(2019 版). 中國實用外科雜志, 2019, 39(4): 301-306.
20.	Braghetto I, Martinez G, Korn O, et al. Laparoscopic subtotal gastrectomy in morbid obese patients: a valid option to laparoscopic gastric bypass in particular circumstances (prospective study). Surg Today, 2018, 48(5): 558-565.
21.	張曉倩. 幽門螺桿菌感染、慢性萎縮性胃炎與胃癌. 臨床消化病雜志, 2016, 28(3): 192-195.
22.	鄭學靜, 桑慶, 王亮, 等. 克氏針擋肝技術在減重手術中的應用: 附 110 例報告. 中國微創外科雜志, 2020, 20(8): 700-703.
23.	Mahawar KK, Kumar P, Parmar C, et al. Small bowel limb lengths and Roux-en-Y gastric bypass: a systematic review. Obes Surg, 2016, 26(3): 660-671.
24.	Wang A, Poliakin L, Sundaresan N, et al. The role of total alimentary limb length in Roux-en-Y gastric bypass: a systematic review. Surg Obes Relat Dis, 2022, 18(4): 555-563.
25.	Eskandaros MS, Abbass A. Standard biliopancreatic limb (50 cm) Roux-en-Y gastric bypass versus long biliopancreatic limb (100 cm) Roux-en-Y gastric bypass in patients with body mass index 40-50 kg/m²: a randomized prospective study. Obes Surg, 2022, 32(3): 577-586.
26.	Nijland LMG, van Sabben JM, Marsman HA, et al. Comparing a short biliopancreatic limb to a long biliopancreatic limb in patients with a Roux-en-Y gastric bypass with 4 years follow-up. Obes Surg, 2021, 31(11): 4846-4852.
27.	Zorrilla-Nunez LF, Campbell A, Giambartolomei G, et al. The importance of the biliopancreatic limb length in gastric bypass: a systematic review. Surg Obes Relat Dis, 2019, 15(1): 43-49.
28.	Ramos AC, Marchesini JC, de Souza Bastos EL, et al. The role of gastrojejunostomy size on gastric bypass weight loss. Obes Surg, 2017, 27(9): 2317-2323.
29.	Lee WJ, Chen JC, Yao WC, et al. Transumbilical 2-site laparoscopic Roux-en-Y gastric bypass: initial results of 100 cases and comparison with traditional laparoscopic technique. Surg Obes Relat Dis, 2012, 8(2): 208-213.
30.	Eagleston J, Nimeri A. Optimal small bowel limb lengths of Roux-en-Y gastric bypass. Curr Obes Rep, 2023, 12(3): 345-354.
31.	Kwon Y, Lee S, Kim D, et al. Biliopancreatic limb length as a potential key factor in superior glycemic outcomes after Roux-en-Y gastric bypass in patients with type 2 diabetes: a meta-analysis. Diabetes Care, 2022, 45(12): 3091-3100.
32.	Zerrweck C, Herrera A, Sepúlveda EM, et al. Long versus short biliopancreatic limb in Roux-en-Y gastric bypass: short-term results of a randomized clinical trial. Surg Obes Relat Dis, 2021, 17(8): 1425-1430.
33.	中華醫學會外科學分會. 腹腔鏡胃外科手術縫合技術與縫合材料選擇中國專家共識(2021 版). 中國實用外科雜志, 2021, 41(5): 495-503.
34.	Orci L, Chilcott M, Huber O. Short versus long Roux-limb length in Roux-en-Y gastric bypass surgery for the treatment of morbid and super obesity: a systematic review of the literature. Obes Surg, 2011, 21(6): 797-804.
35.	Gan J, Wang Y, Zhou X. Whether a short or long alimentary limb influences weight loss in gastric bypass: a systematic review and meta-analysis. Obes Surg, 2018, 28(11): 3701-3710.
36.	Kanaya S, Gomi T, Momoi H, et al. Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg, 2002, 195(2): 284-287.
37.	中國人體健康科技促進會肥胖糖尿病主動健康專業委員會. 中國對稱三孔法腹腔鏡胃袖狀切除術規范化手術操作指南(2023 版). 華西醫學, 2023, 38(12): 1785-1791.
38.	Zhou B, Ji H, Liu Y, et al. ERAS reduces postoperative hospital stay and complications after bariatric surgery: a retrospective cohort study. Medicine (Baltimore), 2021, 100(47): e27831.
39.	中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 精準肥胖代謝外科手術中國專家共識(2022 版). 中華消化外科雜志, 2022, 21(10): 1302-1312.
40.	中國研究型醫院學會糖尿病與肥胖外科專業委員會. 減重與代謝外科加速康復外科原則中國專家共識(2021 版). 中華消化外科雜志, 2021, 20(8): 841-845.

1. Mason EE, Ito C. Gastric bypass in obesity. Surg Clin North Am, 1967, 47(6): 1345-1351.
2. Griffen WO Jr, Young VL, Stevenson CC. A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity. Ann Surg, 1977, 186(4): 500-509.
3. Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg, 1994, 4(4): 353-357.
4. Sandoval DA, Patti ME. Glucose metabolism after bariatric surgery: implications for T2DM remission and hypoglycaemia. Nat Rev Endocrinol, 2023, 19(3): 164-176.
5. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med, 2017, 376(7): 641-651.
6. Courcoulas AP, King WC, Belle SH, et al. Seven-year weight trajectories and health outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) study. JAMA Surg, 2018, 153(5): 427-434.
7. Sj?str?m L. Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med, 2013, 273(3): 219-234.
8. Arterburn DE, Telem DA, Kushner RF, et al. Benefits and risks of bariatric surgery in adults: a review. JAMA, 2020, 24(9): 879-887.
9. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery survey 2018: similarities and disparities among the 5 IFSO chapters. Obes Surg, 2021, 31(5): 1937-1948.
10. 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會, 中國肥胖代謝外科研究協作組. 中國肥胖代謝外科數據庫: 2022 年度報告. 中華肥胖與代謝病電子雜, 2023, 9(2): 83-91.
11. 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 腹腔鏡 Roux-en-Y 胃旁路術規范化手術操作指南(2019 版). 中華肥胖與代謝病電子雜志, 2019, 5(2): 63-69.
12. 楊熠, 陳文輝, 董志勇, 等. 精準肥胖代謝外科理念在腹腔鏡 Roux-en-Y 胃旁路術中的應用. 中華胃腸外科雜志, 2022, 25(10): 875-880.
13. 高磊, 胡揚喜, 胡德升, 等. 對稱 3 孔法腹腔鏡袖狀胃切除術的臨床應用價值. 中華消化外科雜志, 2019, 18(9): 854-858.
14. 劉洋, 劉歡妹, 魏丹, 等. 三孔法腹腔鏡胃袖狀切除術治療肥胖癥的臨床療效. 中華消化外科雜志, 2017, 16(6): 566-570.
15. 董星, 胡揚喜, 李英, 等. 三孔法腹腔鏡胃袖狀切除術治療極重度肥胖合并心肌病的應用體會. 腹腔鏡外科雜志, 2021, 26(7): 256-259.
16. 牛牧天, 孟化, 胡揚喜, 等. 對稱三孔法腹腔鏡袖狀胃切除術治療原發性高血壓的療效分析. 腹腔鏡外科雜志, 2022, 27(2): 90-95.
17. 紀浩洋, 劉宇萌, 張潔, 等. 對稱三孔法腹腔鏡袖狀胃切除術治療 2 型糖尿病的療效分析. 中華普通外科雜志, 2020, 35(7): 569-570.
18. Zhou B, Cao X, Wang Z, et al. Symmetric three-port laparoscopic Roux-en-Y gastric bypass: a novel technique that is safe, effective, and feasible. Surg Today, 2023, 53(6): 702-708.
19. 中華醫學會外科學分會甲狀腺及代謝外科學組, 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 中國肥胖及 2 型糖尿病外科治療指南(2019 版). 中國實用外科雜志, 2019, 39(4): 301-306.
20. Braghetto I, Martinez G, Korn O, et al. Laparoscopic subtotal gastrectomy in morbid obese patients: a valid option to laparoscopic gastric bypass in particular circumstances (prospective study). Surg Today, 2018, 48(5): 558-565.
21. 張曉倩. 幽門螺桿菌感染、慢性萎縮性胃炎與胃癌. 臨床消化病雜志, 2016, 28(3): 192-195.
22. 鄭學靜, 桑慶, 王亮, 等. 克氏針擋肝技術在減重手術中的應用: 附 110 例報告. 中國微創外科雜志, 2020, 20(8): 700-703.
23. Mahawar KK, Kumar P, Parmar C, et al. Small bowel limb lengths and Roux-en-Y gastric bypass: a systematic review. Obes Surg, 2016, 26(3): 660-671.
24. Wang A, Poliakin L, Sundaresan N, et al. The role of total alimentary limb length in Roux-en-Y gastric bypass: a systematic review. Surg Obes Relat Dis, 2022, 18(4): 555-563.
25. Eskandaros MS, Abbass A. Standard biliopancreatic limb (50 cm) Roux-en-Y gastric bypass versus long biliopancreatic limb (100 cm) Roux-en-Y gastric bypass in patients with body mass index 40-50 kg/m²: a randomized prospective study. Obes Surg, 2022, 32(3): 577-586.
26. Nijland LMG, van Sabben JM, Marsman HA, et al. Comparing a short biliopancreatic limb to a long biliopancreatic limb in patients with a Roux-en-Y gastric bypass with 4 years follow-up. Obes Surg, 2021, 31(11): 4846-4852.
27. Zorrilla-Nunez LF, Campbell A, Giambartolomei G, et al. The importance of the biliopancreatic limb length in gastric bypass: a systematic review. Surg Obes Relat Dis, 2019, 15(1): 43-49.
28. Ramos AC, Marchesini JC, de Souza Bastos EL, et al. The role of gastrojejunostomy size on gastric bypass weight loss. Obes Surg, 2017, 27(9): 2317-2323.
29. Lee WJ, Chen JC, Yao WC, et al. Transumbilical 2-site laparoscopic Roux-en-Y gastric bypass: initial results of 100 cases and comparison with traditional laparoscopic technique. Surg Obes Relat Dis, 2012, 8(2): 208-213.
30. Eagleston J, Nimeri A. Optimal small bowel limb lengths of Roux-en-Y gastric bypass. Curr Obes Rep, 2023, 12(3): 345-354.
31. Kwon Y, Lee S, Kim D, et al. Biliopancreatic limb length as a potential key factor in superior glycemic outcomes after Roux-en-Y gastric bypass in patients with type 2 diabetes: a meta-analysis. Diabetes Care, 2022, 45(12): 3091-3100.
32. Zerrweck C, Herrera A, Sepúlveda EM, et al. Long versus short biliopancreatic limb in Roux-en-Y gastric bypass: short-term results of a randomized clinical trial. Surg Obes Relat Dis, 2021, 17(8): 1425-1430.
33. 中華醫學會外科學分會. 腹腔鏡胃外科手術縫合技術與縫合材料選擇中國專家共識(2021 版). 中國實用外科雜志, 2021, 41(5): 495-503.
34. Orci L, Chilcott M, Huber O. Short versus long Roux-limb length in Roux-en-Y gastric bypass surgery for the treatment of morbid and super obesity: a systematic review of the literature. Obes Surg, 2011, 21(6): 797-804.
35. Gan J, Wang Y, Zhou X. Whether a short or long alimentary limb influences weight loss in gastric bypass: a systematic review and meta-analysis. Obes Surg, 2018, 28(11): 3701-3710.
36. Kanaya S, Gomi T, Momoi H, et al. Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg, 2002, 195(2): 284-287.
37. 中國人體健康科技促進會肥胖糖尿病主動健康專業委員會. 中國對稱三孔法腹腔鏡胃袖狀切除術規范化手術操作指南(2023 版). 華西醫學, 2023, 38(12): 1785-1791.
38. Zhou B, Ji H, Liu Y, et al. ERAS reduces postoperative hospital stay and complications after bariatric surgery: a retrospective cohort study. Medicine (Baltimore), 2021, 100(47): e27831.
39. 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 精準肥胖代謝外科手術中國專家共識(2022 版). 中華消化外科雜志, 2022, 21(10): 1302-1312.
40. 中國研究型醫院學會糖尿病與肥胖外科專業委員會. 減重與代謝外科加速康復外科原則中國專家共識(2021 版). 中華消化外科雜志, 2021, 20(8): 841-845.

West China Medical Journal

Chinese standardized surgical guideline for symmetric three-port laparoscopic Roux-en-Y gastric bypass (2023 edition)

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