The Mistake of the Twisted PouchAnterior Gastro-Jejunostomy (No it is Not A Good Idea!)

1. Mini-Gastric Bypass
Technical Errors, Tips & Pointers
The Mistake of the
Twisted Pouch
Anterior Gastro-Jejunostomy
(No it is Not A Good Idea!)

2. Errors in Creating the Gastric Pouch
Correct Pouch
How the MGB Gastric Pouch
Should Lie:
Like a Normal Stomach
Medial = Lesser Curvature
180 Degrees
Lateral = Neo-Greater Curvature

3. Errors in Creating the Gastric Pouch
“TWISTED” Pouch
How the MGB Gastric Pouch
Should NOT Lie: WRONG
NOT Like a Normal Stomach
Medial = Lesser Curvature
180 Deg Twist
9 O'clock to 3 o'clock
Lateral = Neo-Greater Curvature
Twist

4. Errors in Creating the Gastric Pouch
“TWISTED” Pouch
How the MGB Gastric Pouch
Should NOT Lie: WRONG
NOT Like a Normal Stomach
Medial = Lesser Curvature
180 Deg Twist
9 O'clock to 3 o'clock
Lateral = Neo-Greater Curvature
Twist

5. Doing the MGB Wrong
The Twisted Gastric Pouch
The Neo-Gastric Pouch Should not be twisted
That should be obvious
The lesser curve should lie at 9 o'clock, medially
The Neo-Greater curvature should lie at 3 o'clock, laterally
Twisted (Wrong) pouch makes the anterior GJ “look” like a good
choice

6. The Twisted Gastric Pouch
Often Leads to Post Op Complications
Twisted Gastric Pouch Syndrome:
Post op
Nausea and vomiting
CTScan, Endoscopy all negative
“INVISIBLE ILLNESS”
Rx: Revision
Prevention: Simple, Do Not Twist the Pouch &
Never Anterior Anastomosis