Distalization of Roux-en-Y Gastric Bypass: Lengthening the Biliopancreatic Limb

Laparoscopic Roux-en-Y gastric bypass is an effective surgical procedure to manage obesity and associated comorbidities. Despite this, some patients experience suboptimal weight loss or weight regain. Several revisional options are available following gastric bypass. Distalization, by increasing the biliopancreatic limb and decreasing the common channel, has been previously shown to improve weight loss with low perioperative morbidity. The impact on weight and nutritional deficiencies is associated with lengths of the different intestinal limbs. Although gastric bypass distalization is an established procedure, in this video we present some technical tips and peals.