Fewer gastrojejunostomy strictures and marginal ulcers with absorbable suture

Area of Science:

• Bariatric Surgery
• Surgical Innovation
• Gastrointestinal Surgery

Background:

• Gastric bypass procedures are increasing, leading to more anastomotic strictures and marginal ulcers.
• Gastrojejunostomy strictures occur in 3-31% and ulcers in 1-16% of cases.
• The impact of reinforcing suture choice on these complication rates is not well-studied.

Purpose of the Study:

• To determine if a change in suture material affects the incidence of anastomotic strictures and marginal ulcers after gastric bypass.
• To compare complication rates between permanent and absorbable reinforcing sutures.

Main Methods:

• Retrospective review of 315 primary Roux-en-Y gastric bypass patients.
• Comparison of interrupted permanent sutures (n=231) versus interrupted absorbable sutures (n=84) for stapled anastomosis reinforcement.
• Statistical analysis using proportional hazards model and log-rank test.

Main Results:

• Fewer gastrojejunostomy complications observed with absorbable sutures (4.7%) versus permanent sutures (19.9%).
• Marginal ulcers were significantly lower with absorbable sutures (2.3%) compared to permanent sutures (13.4%).
• Anastomotic strictures were less frequent with absorbable sutures, though not statistically significant.

Conclusions:

• Absorbable reinforcing sutures are linked to reduced gastrojejunostomy complications.
• Recommend absorbable sutures for the outer layer of stapled gastrojejunal anastomoses in Roux-en-Y gastric bypass.
• This practice may lower the incidence of marginal ulcers and overall complications.