V lock 3 0

The gastric pouch was constructed by creating a window in the lesser omentum with a harmonic scalpel at the crow’s foot and firing a 45-mm cartridge horizontally and 4–5 cartridges vertically guided by a 36 F bougie for pouch calibration. The gastrojejunostomy was constructed at a distance of 250 cm from the duodenojejunal (DJ) junction by a 45-mm cartridge after measuring the entire length of the small intestine to make sure that TBL > 6 m. A minimum of 350 cm of the small intestine was ensured to be present distally to prevent the incidence of a short common limb (CL). Shorter lengths of the small intestine were allowed to have the RYGB procedure to be carried out instead and not included in the study. The enterotomies were then closed using V-lock sutures (V-lock 3/0, Medtronic™, Minneapolis, USA). The afferent and efferent loops were then fixed to the remnant stomach and the pylorus respectively using non-absorbable sutures to minimize reflux and facilitate the passage of food. An 18 F drain was left in the surgical bed.

Standard technique for OAGB/MGB has been previously reported [19 (link), 20 (link)]: a six-port (5 × 10 mm, 1 × 5 mm) approach was used. The gastric pouch was fashioned along a 36-Fr starting just below the crow’s foot. No reinforcement was routinely applied on the staple line. Initially the biliopancreatic limb (BPL) had a fixed length of 200 cm, but after the first cases BPL was tailored on the patient’s BMI (Body Mass Index) [21 (link)]. The gastrojejunostomy was performed using a 45-mm linear stapler and enterotomies were closed by an anterior, double-layer, self- locking, running absorbable suture (V-lock 3/0, Medtronic™, Minneapolis, U.S.A.). Upper endoscopy is not used in our institution to check the anastomosis, but a methylene blue test is performed.
The nasogastric tube was removed the evening of the surgery and an abdominal drain was routinely placed behind the anastomosis. A liquid diet was started on postoperative day 3 and discharge was scheduled in case of no clinical signs of leak or stenosis.