Clip closure and division instead of stapling for the last small gastric bridge between gastric pouch and remnant stomach in laparoscopic Roux-en-Y gastric bypass.

INTRODUCTION: Here, a modification during gastric pouch forming was implemented in laparoscopic Roux-en-Y gastric bypass (LRYGB). We aimed to examine the feasibility of metallic clip closure for the remaining small stomach bridges (<1 cm) between the pouch and the remnant stomach.

METHODS: During pouch creation, after the last stapler firing, the remaining small bridge was closed with clips and divided instead of using a new stapler. Metallic clips for this aim were used in 41 of 520 LRYGP between September 2010 and January 2017. Preoperative mean body mass index (BMI) was 47.3 ± 5.3 kg/m2 (male/female: 6/35, mean age 37.8 ± 9.1 years).

RESULTS: Gastric bridges in 41 patients were successfully closed with metallic clips and divided. In one patient, intraoperative methylene blue test was positive from the anastomosis (not from the clipped place) and repaired by intracorporeal sutures. Abdominal drain was used selectively (32%). No postoperative leakage or other complications were seen. Mean length of hospital stay was 3.8 ± 1.1 days. Mean BMI was 30.3 ± 6.1 kg/m2 after mean 17.6 ± 11.3 months follow-up.

CONCLUSION: In LRYGB metallic clip closure for a stomach bridge (<1 cm) between the pouch and the remnant stomach is an easy, safe and reliable method.