APPENDIX II: BOSATS LRYGB Relevant items of the BOSATS for a linear stapled antecolic gastrojejunostomy by Zevin et al.23 TASK / STEP 1 2 3 4 5 N/A Placement of liver retractor Elevate the transverse colon cephalad and identify ligament of Treitz Not performed Performed in a traumatic fashion; ligament identified Elevated smoothly and gently; good exposure of ligament Measure approximately 40-60 cm of jejunum distal to the ligament of Treitz Length not measured Measured, however individual measurements not of the same size; poor orientation Measured methodologically; each measurement of the same size; correct orientation Confirm that this part of jejunum will reach the hiatus / gastric pouch Not confirmed Confirmed briefly Confirmed clearly and methodologically Divide jejunum Divided with tissue trauma and gross contamination Bowel divided; jaws of stapler not perpendicular to bowel; possibility of mesenteric trauma; need for re-resection Bowel divided at correct angle; good viability of ends; no trauma to mesentery Creation of the JJ anastomosis Preparation Measure 75-150 cm length of Rouxlimb Length not measured Measured, however individual measurements not of the same size; poor orientation; grabs onto mesentery Measured methodologically; each measurement of the same size; correct orientation Bring distal end of BPL and position side to side to Roux limb Incorrect orientation of BPL to Roux limb Correct orientation, although required multiple attempts with extra movements BPL positioned correctly in relation to Roux limb; no extra movements; no tension 100 5
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