To achieve the best outcomes after a laparoscopic Roux-en-Y gastric bypass, the surgeon must standardize all intraoperative steps. In this video, we describe how we perform the operation. After port placement, the greater omentum is divided up to the transverse colon to prevent potential tension, as the Roux limb will go antecolic. Limb lengths are determined and the jejuno-jejunostomy is performed. There is much controversy about the ideal limb lengths, however more robust data are needed to determine whether longer limbs deliver better outcomes without long-term nutritional complications. The enterotomies are closed with a running non-absorbable suture. The mesenteric defect is closed with non-absorbable suture. Then, we create the gastric pouch with blue stapler loads and the gastrojejunostomy with the linear stapler. The gastrotomy and enterotomy are closed with a running non-absorbable suture. Afterwards, we routinely perform an air-leak test to check the anastomosis integrity. Finally, Petersen’s defect is closed with non-absorbable suture.
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