Table 4: Delphi Consensus on Laparoscopic Gastric Bypass and Sleeve Gastrectomy Key steps laparoscopic linear stapled gastric bypass Operative set up Checking of instruments Positioning OR team Positioning monitors Positioning patient Time-out procedure Checking of antibiotic prophylaxis Disinfection, sterile exposure Checking introduction gastric bougie Starting of laparoscopy Introduction optical trocar Introduction of additional trocars under laparoscopic sight Introduction of liver retractor Exposure of operative field Creation of the gastric pouch Opening pars flacid and lesser sac Checking gastric bougie position Stapling horizontally Detachment of posterior attachments stomach Dissecting angle of His ventral side Final stapling pouch Haemostatic checking of stapleline Creation of biliopancreatic limb Determine length of biliopancreatic limb Lift transverse colon Identification of Treitz' ligament Measure jejunum starting from Treitz' ligament Running the jejunum in a clockwise manner Gastrojejunal anastomosis Checking possibility for a tension free anastomosis Opening of the pouch Opening jejunum Stapled gastrojejunal anastomosis Completing gastrojejunal anastomosis with sutures Creation of alimentary limb Determine length of alimentary limb Measuring small bowel starting from pouch Running the small bowel in counter clockwise manner Jejunojejunal anastomosis Opening efferent limb Opening afferent limb Stapled jejunojejunal anastomosis Completing jejunojejunal anastomosis with sutures Advancing the gastric tube through anastomosis Finishing the bypass Transecting small bowel between gastrojejunal and jejunojejunal anastomosis (continued) 72 4
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