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Gastrojejunostomy technique and anastomotic complications in laparoscopic gastric bypass
Alex W Lois1, Matthew J Frelich1, Matthew I Goldblatt1
1Medical College of Wisconsin, Department of Surgery, Milwaukee, Wisconsin.
Insights
The circular-stapled anastomosis (CSA) for gastric bypass surgery has more complications than the hand-sewn anastomosis (HSA). However, both techniques result in similar weight loss and hospital stays.
Area of Science:
- Bariatric Surgery
- Surgical Techniques
- Gastrointestinal Surgery
Background:
- Laparoscopic Roux-en-Y gastric bypass (LRYGB) utilizes various gastrojejunostomy techniques.
- Hand-sewn anastomosis (HSA) and circular-stapled anastomosis (CSA) are common methods.
- The study investigates complication rates and weight loss associated with each technique.
Purpose of the Study:
- To compare the incidence of anastomotic complications between HSA and CSA techniques in LRYGB.
- To evaluate differences in weight loss between the two gastrojejunostomy methods.
- To analyze operative time and length of hospital stay for each technique.
Main Methods:
- Retrospective review of 190 LRYGB patients from January 2010 to December 2011.
- Procedures performed by surgeons with preferred gastrojejunostomy techniques.
- Patient outcomes followed for up to one year post-surgery.
Main Results:
- Anastomotic complications, including marginal ulcers and stenosis, were more frequent with CSA (P=.04, P=.01).
- CSA patients had a higher incidence of Clavien Classification Grade III complications within 30 days (10.9% vs 2.2%).
- Weight loss at 12 months was comparable (76.6% EBMIL CSA vs 69.4% EBMIL HSA), despite longer operative times for HSA (P<.01).
Conclusions:
- CSA is associated with a higher rate of non-life-threatening anastomotic complications compared to HSA.
- HSA involves longer operative times, but LOS and long-term weight loss are equivalent between techniques.
- No gastrojejunostomy leaks were observed in this series.
Background:
Various surgical techniques exist to create the gastrojejunostomy during laparoscopic Roux-en-Y gastric bypasses (LRYGB). A hand-sewn anastomosis (HSA) and circular-stapled anastomosis (CSA) are both common techniques. We hypothesized that the CSA was associated with a greater incidence of anastomotic complications. As a secondary aim, we sought to determine if weight loss varied by technique.
Methods:
This study is a retrospective review of patients who underwent primary LRYGB at the Medical College of Wisconsin from January 2010 to December 2011. Procedures were performed by one of 2 surgeons, each with a preferred gastrojejunostomy technique. Clinical information and patient outcomes were followed up to one year.
Results:
A total of 190 patients underwent LRYGB during the study interval. The majority of patients underwent HSA. Forty-one of 190 (21.6%) patients experienced one or more complications. Most complications were Clavien Classification Grade III and were experienced within 30 days of surgery in 3 (2.2%) HSA patients and 6 (10.9%) CSA patients (P = .02). Anastomotic complications occurred more frequently with the CSA technique (marginal ulcer 5.5% CSA versus .7% HSA; P = .04 and stenosis 16.4% CSA versus 3% HSA; P = .01). There were no gastrojejunostomy leaks in this series. Operative time was significantly longer in HSA patients (204 minutes HSA versus 166 minutes CSA; P<.01), but length of hospital stay did not differ. Weight loss at 12 months was similar between techniques (69.4% percent excess BMI lost (EBMIL) HSA versus 76.6% EBMIL CSA; P = .11). No patients were lost to follow-up at 30 days. Thirty-five patients (19%) were lost to follow-up by one year.
Conclusion:
The CSA technique of gastrojejunostomy in gastric bypass is associated with a higher rate of nonlife threatening anastomotic complications than the HSA technique. Operative times are significantly longer for HSA, but length of hospital stay (LOS) and long-term weight loss are equivalent.
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