Totally Extramucosal Hand-Sewn Robotic Gastrojejunostomy for Roux-en-Y Gastric Bypass

Background: Roux-en-Y gastric bypass is an established metabolic-bariatric procedure performed using minimally invasive approaches, including laparoscopy and robotic assistance. Robotic platforms provide technical advantages that facilitate hand-sewn gastrojejunostomy, allowing surgeons to implement a consistent and reproducible technique. Methods: The surgical technique of a single-layer, continuous, extramucosal hand-sewn gastrojejunostomy performed during fully robotic Roux-en-Y gastric bypass is described. Consecutive primary and revisional procedures were performed by a single bariatric surgeon using the da Vinci X, Xi, or 5 robotic platforms. Perioperative outcomes were analyzed. An accompanying video is accessible to demonstrate our operative technique. Results: Between April 1, 2024, and January 31, 2026, 73 consecutive Roux-en-Y gastric bypass procedures were performed by a single surgeon, including 34 primary and 39 revisional cases. Using the described suturing technique, no anastomotic leaks or gastrojejunostomy-related bleeding were observed. One anastomotic stricture occurred within the 30-day postoperative period and was successfully managed with endoscopic dilation. Summary: The described single-layer, continuous, extramucosal robotic hand-sewn gastrojejunostomy in Roux-en-Y gastric bypass was feasible and safe in a consecutive series of primary and revisional procedures.