Transoral outlet reduction: a comparison of purse-string with interrupted stitch technique

Weight regain after Roux-en-Y gastric bypass (RYGB) correlates with dilated gastrojejunal anastomosis (GJA). Endoscopic sutured transoral outlet reduction (TORe) is a safe and effective management and has predominantly been performed by either placing interrupted sutures at the GJA or the creation of a purse-string suture. The aim of the current study was to compare these techniques.

All patients undergoing TORe for weight regain after RYGB were prospectively enrolled. Primary outcome was mean percent total weight loss (%TWL) at 3 and 12 months. Secondary outcomes included percent excess weight loss (%EWL), percent regained weight lost (%RWL), and total weight loss. Proportions were compared using the Fisher exact test and continuous variables using the Student t test. A P = .05 was significant. Multivariable regression analysis was performed.

Two hundred forty-one patients were enrolled (purse string = 187, interrupted = 54). There was no statistical difference between the purse-string and interrupted groups at 3 months in %TWL (8.6 vs 8.0, P = .41), %EWL (20.5 vs 16.7, P = .39), % RWL (44.7 vs 33.3, P = .56), and total weight loss (9.5 vs 11.3, P = .32). At 12 months the purse-string group achieved statistically significant improvement in %TWL (8.6 vs 6.4, P = .02), %EWL (19.8 vs 11.7, P < .001), %RWL (40.2 vs 27.8, P = .02), and total weight loss (9.5 vs 7.8, P = .04). Multivariable regression showed that technique (P = .006) was an independent predictor of %TWL at 12 months.

TORe is effective in treatment of weight regain after failed gastric bypass. The purse-string technique results in greater weight loss at 12 months than the traditional interrupted suture pattern.