Knotless tissue control devices for hand-sewn gastrojejunostomy in robotic-assisted Roux-en-Y gastric bypass

Literature on clinical and economic outcomes with hand-sewn gastrojejunostomy using Spiral Antibacterial Knotless Tissue Control Devices (KTCD) in Roux-en-Y gastric bypass (RYGB) is scant.

Assess clinical and economic outcomes of patients receiving KTCD for hand-sewn gastrojejunostomy vs. alternative means of anastomosis in robotic-assisted RYGB.

US hospital.

Patients who received gastrojejunostomy using KTCD in robotic-assisted RYGB between 01/01/2020-08/31/2023 identified in the Premier Healthcare Database (PHD) were evaluated via medical chart review (RYGB=index). Patients with alternative means of anastomosis, including non-KTCD sutures/staplers, in robotic-assisted RYGB in the PHD during the same timeframe were utilized as controls. Optimization-based stable balance weighting balanced the cohorts on baseline characteristics. Outcomes included a composite complication measure (anastomotic leak, bleeding, dilation of small intestine, infection, pelvic abscess, ileus/bowel obstruction) evaluated at index, index through 30 days and 90 days, anastomotic leak through 90 days, length of stay (LOS), and index costs.

145 patients in two hospitals met KTCD selection criteria; 6,491 met control criteria. Incidences of complications at index, 30 days, and 90 days were lower for KTCD vs. controls (0.7% vs. 4.5%, 0.7% vs. 7.3%, 2.1% vs. 8.3%; all p<0.01). LOS was shorter for KTCD vs. controls (1.34 vs. 1.62 days; p=0.002). Anastomotic leaks (1.4% vs. 2.0%; p=0.143) and index costs ($17,042 vs. $16,431; p=0.494) did not differ between KTCD vs. controls.

This retrospective analysis of gastrojejunostomy in robotic-assisted RYGB found fully hand-sewn gastrojejunostomy with KTCD was associated with lower complication rates and shorter LOS vs. alternative means of anastomosis.