Laparoscopic Roux-en-“W” Gastric Bypass

OBJECTIVES: Roux-en-Y gastric bypass is the gold standard for treating morbid obesity in this country. The totally laparoscopic performance of this procedure, although quite demanding and technically difficult, has revolutionized it; and the demand for it has skyrocketed. We describe 2 cases where it became necessary to convert the Y into a “W” while performing the procedure. METHODS: A laparoscopic Roux-en-Y gastric bypass was attempted on 2 patients, 1 male and 1 female, both with body mass indexes greater than 40. During creation of the side to side jejunojejunostomy, ie, the Y, it became obvious that stenosis or obstruction would result. This area was partially resected and an additional side to side anastomosis was formed, creating a “W.” RESULTS: The operative time was 205 minutes and 180 minutes, respectively, which compared favorably with the average operative time of 151 minutes in that quartile of patients (patients #101–#150). Both patients had normal upper gastrointestinal and small bowel contrast x-rays the day following surgery and were started on clear liquids. They were discharged later that day. Weight loss of 119 lb at 8 months and 80 lb at 6 months was documented, respectively, with no gastrointestinal sequelae. CONCLUSION: If problems are encountered when creating the Y of a laparoscopic Roux-en-Y gastric bypass, a laparoscopic Roux-en-W may be performed. It appears safe, technically feasible, and with a postoperative course not unlike that of the standard approach.