Effect of circular staple line buttressing material on gastrojejunostomy failure in laparoscopic Roux-en-Y gastric bypass

To determine the effect of bovine pericardium strip (BPS) reinforcement of the circular stapler on the gastrojejunostomy leak rates and staple line failure after laparoscopic Roux-en-Y gastric bypass (LRYGB) at a university hospital in the United States. Gastrojejunostomy leak after LRYGB is a devastating complication. Various techniques, including buttressing the gastrojejunostomy staple line with biomaterial, have been used in an effort to minimize leaks.

A total of 350 consecutive patients underwent LRYGB without staple line buttressing. After this initial experience, BPS reinforcement of the gastrojejunostomy was conducted in 81 consecutive patients. BPS reinforcement was not used for the final 69 consecutive patients in this 500 patient series. Circular staple line failures (intraoperative immediate and complete failure of the anastomosis) and leaks were evaluated retrospectively.

Three leaks (and no intraoperative staple line failures) occurred in 419 patients without BPS buttressing, all in the first 100 cases of our experience, and 3 leaks and an anastomotic staple line failure occurred in the 81 patients with BPS buttressing (.7% versus 4.9%, P = .02). The body mass index and other potential leak risk factors did not differ between the 2 groups.

In our experience, buttressing of the circular staple line with BPS during LRYGB was associated with an increased staple line adverse event rate. BPS buttressing of the gastrointestinal circular staple lines should be used with caution.