[Anastomotic techniques in minimally invasive bariatric surgery]

Area of Science:

• Bariatric Surgery
• Surgical Techniques
• Gastrointestinal Surgery

Context:

• Laparoscopic bariatric surgery lacks standardized anastomotic technique recommendations.
• Key considerations include insufficiency, bleeding, stricture, ulceration, weight loss, and dumping.
• Evidence review focuses on Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), single anastomosis sleeve ileal (SASI) bypass, and biliopancreatic diversion with duodenal switch (BPD-DS).

Purpose:

• To review current evidence on anastomotic techniques in common laparoscopic bariatric procedures.
• To identify potential advantages or disadvantages of different techniques based on available literature.

Summary:

• Comparative studies are scarce, particularly for OAGB, SASI, and BPD-DS.
• In RYGB, manual suture and mechanical anastomosis show comparable outcomes.
• Linear staplers may reduce wound infections and bleeding compared to circular staplers in RYGB.
• OAGB and SASI allow for linear stapler or manual closure.
• Manual anastomosis appears beneficial for BPD-DS.

Impact:

• Current evidence is insufficient to establish definitive recommendations for most laparoscopic bariatric anastomotic techniques.
• RYGB shows a potential advantage for linear stapler techniques combined with manual closure.
• Highlights the need for prospective, randomized controlled trials to guide clinical practice and improve patient outcomes.