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

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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.	Sjöström 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.	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库: 2022 年度报告. 中华肥胖与代谢病电子杂, 2023, 9(2): 83-91.
11.	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 腹腔镜 Roux-en-Y 胃旁路术规范化手术操作指南(2019 版). 中华肥胖与代谢病电子杂志, 2019, 5(2): 63-69.
12.	杨熠, 陈文辉, 董志勇, 等. 精准肥胖代谢外科理念在腹腔镜 Roux-en-Y 胃旁路术中的应用. 中华胃肠外科杂志, 2022, 25(10): 875-880.
13.	高磊, 胡扬喜, 胡德升, 等. 对称 3 孔法腹腔镜袖状胃切除术的临床应用价值. 中华消化外科杂志, 2019, 18(9): 854-858.
14.	刘洋, 刘欢妹, 魏丹, 等. 三孔法腹腔镜胃袖状切除术治疗肥胖症的临床疗效. 中华消化外科杂志, 2017, 16(6): 566-570.
15.	董星, 胡扬喜, 李英, 等. 三孔法腹腔镜胃袖状切除术治疗极重度肥胖合并心肌病的应用体会. 腹腔镜外科杂志, 2021, 26(7): 256-259.
16.	牛牧天, 孟化, 胡扬喜, 等. 对称三孔法腹腔镜袖状胃切除术治疗原发性高血压的疗效分析. 腹腔镜外科杂志, 2022, 27(2): 90-95.
17.	纪浩洋, 刘宇萌, 张洁, 等. 对称三孔法腹腔镜袖状胃切除术治疗 2 型糖尿病的疗效分析. 中华普通外科杂志, 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.	中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖及 2 型糖尿病外科治疗指南(2019 版). 中国实用外科杂志, 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.	张晓倩. 幽门螺杆菌感染、慢性萎缩性胃炎与胃癌. 临床消化病杂志, 2016, 28(3): 192-195.
22.	郑学静, 桑庆, 王亮, 等. 克氏针挡肝技术在减重手术中的应用: 附 110 例报告. 中国微创外科杂志, 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.	中华医学会外科学分会. 腹腔镜胃外科手术缝合技术与缝合材料选择中国专家共识(2021 版). 中国实用外科杂志, 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.	中国人体健康科技促进会肥胖糖尿病主动健康专业委员会. 中国对称三孔法腹腔镜胃袖状切除术规范化手术操作指南(2023 版). 华西医学, 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.	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 精准肥胖代谢外科手术中国专家共识(2022 版). 中华消化外科杂志, 2022, 21(10): 1302-1312.
40.	中国研究型医院学会糖尿病与肥胖外科专业委员会. 减重与代谢外科加速康复外科原则中国专家共识(2021 版). 中华消化外科杂志, 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. Sjöström 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. 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库: 2022 年度报告. 中华肥胖与代谢病电子杂, 2023, 9(2): 83-91.
11. 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 腹腔镜 Roux-en-Y 胃旁路术规范化手术操作指南(2019 版). 中华肥胖与代谢病电子杂志, 2019, 5(2): 63-69.
12. 杨熠, 陈文辉, 董志勇, 等. 精准肥胖代谢外科理念在腹腔镜 Roux-en-Y 胃旁路术中的应用. 中华胃肠外科杂志, 2022, 25(10): 875-880.
13. 高磊, 胡扬喜, 胡德升, 等. 对称 3 孔法腹腔镜袖状胃切除术的临床应用价值. 中华消化外科杂志, 2019, 18(9): 854-858.
14. 刘洋, 刘欢妹, 魏丹, 等. 三孔法腹腔镜胃袖状切除术治疗肥胖症的临床疗效. 中华消化外科杂志, 2017, 16(6): 566-570.
15. 董星, 胡扬喜, 李英, 等. 三孔法腹腔镜胃袖状切除术治疗极重度肥胖合并心肌病的应用体会. 腹腔镜外科杂志, 2021, 26(7): 256-259.
16. 牛牧天, 孟化, 胡扬喜, 等. 对称三孔法腹腔镜袖状胃切除术治疗原发性高血压的疗效分析. 腹腔镜外科杂志, 2022, 27(2): 90-95.
17. 纪浩洋, 刘宇萌, 张洁, 等. 对称三孔法腹腔镜袖状胃切除术治疗 2 型糖尿病的疗效分析. 中华普通外科杂志, 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. 中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖及 2 型糖尿病外科治疗指南(2019 版). 中国实用外科杂志, 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. 张晓倩. 幽门螺杆菌感染、慢性萎缩性胃炎与胃癌. 临床消化病杂志, 2016, 28(3): 192-195.
22. 郑学静, 桑庆, 王亮, 等. 克氏针挡肝技术在减重手术中的应用: 附 110 例报告. 中国微创外科杂志, 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. 中华医学会外科学分会. 腹腔镜胃外科手术缝合技术与缝合材料选择中国专家共识(2021 版). 中国实用外科杂志, 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. 中国人体健康科技促进会肥胖糖尿病主动健康专业委员会. 中国对称三孔法腹腔镜胃袖状切除术规范化手术操作指南(2023 版). 华西医学, 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. 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 精准肥胖代谢外科手术中国专家共识(2022 版). 中华消化外科杂志, 2022, 21(10): 1302-1312.
40. 中国研究型医院学会糖尿病与肥胖外科专业委员会. 减重与代谢外科加速康复外科原则中国专家共识(2021 版). 中华消化外科杂志, 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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