A bidirectional stapling technique for laparoscopic small bowel anastomosis

Valerie A. Marks, Josefina Farra, Francisco Jacome, Nestor De La Cruz-Muñoz

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background Small bowel anastomoses can present a technical challenge during laparoscopic procedures, particularly gastric bypass procedures. Early small bowel obstruction (SBO) rates associated with such procedures occur in.7%-5.2% of patients. Herein, we describe how a bidirectional stapling technique moves the enterotomy to the center of the anastomosis, decreasing the chances of an afferent limb obstruction. Methods A prospectively collected cohort of 2263 consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass with bidirectional stapling of the small bowel anastomosis was evaluated for early SBO. All patients met the National Institutes of Health criteria for bariatric surgery. Results Overall, 3 patients' perioperative courses were complicated by perioperative, early SBO (.13%). These instances were all attributable to intraluminal blood clots and not from inadvertent narrowing of the afferent limb. One was diagnosed on postoperative day 1 by upper gastrointestinal study (UGI); 2 were diagnosed on postoperative day 2 by computed tomography (CT) scan with oral contrast. All 3 patients' complications were managed with a laparoscopic operation. Conclusion The bidirectional stapling technique for small bowel anastomoses, with our modifications, is a rapid, well-tolerated, and effective technique that offers potential advantages over standard laparoscopic anastomotic techniques by reducing perioperative SBO complications.

Original languageEnglish (US)
Pages (from-to)736-742
Number of pages7
JournalSurgery for Obesity and Related Diseases
Issue number5
StatePublished - Sep 2013


  • Bidirectional stapling
  • Laparoscopic Roux-en-Y gastric bypass
  • Laparoscopic small bowel anastomosis
  • Perioperative complication
  • Small bowel obstruction
  • Stenosis

ASJC Scopus subject areas

  • Surgery


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