Conclusion
This video report shows how a large distance between a newly created gastric pouch and the alimentary limb can be bridged, By dissecting the gastro-oesophageal junction from the crus, stretching the pouch, transecting the mesentery of the jejunum, using a retrocolic/retrogastric route and creating a hand-sewn anastomosis we were able to bridge a 8 cm gap. All these manoeuvres are not part of our standard surgical technique as they are all associated with adverse patient outcome. We stress that only experienced bariatric surgeons should embark on these techniques. Inspection of the alimentary limb before pouch created might prevent the need for these complex techniques.