Ante-hepatic gastrojejunostomy

Surgical treatment of morbid obesity continues to increase in popularity. The evolution of laparoscopic techniques has in part fueled that popularity. A common obstacle in achieving exposure of the angle of His during a laparoscopic Roux-en-Y gastric bypass is a massively enlarged liver. Exposure of the angle of His is key to successfully creating the gastric pouch and completing the gastrojejunostomy. Several well-described techniques exist to achieve this exposure but suffer from potential draw backs such as bleeding and the need to insert additional trocars. We describe a technique that allows safe, excellent exposure of the gastroesophageal junction during laparoscopic Roux-en-Y gastric bypass.