Abstract
Background
The two basic techniques available in which to perform the gastrojejunal (GJ) anastomosis during a laparoscopic Roux-en-Y gastric bypass (LRYGBP) are stapled and handsewn. Few outcomes differences have been noted between the two to recommend one as a superior approach. We present our findings in comparison of the two methods.
Methods
This is a retrospective review of all patients who underwent LRYGBP at a single institution during a 3-year period. The two different techniques that were used were a linear stapled and handsewn anastomosis with an anastomotic diameter of 18 mm. The groups were compared for postoperative complications, including stricture, anastomotic leak, and the need for early reoperation. All patients were followed up for a minimum period of 8 months.
Results
A total of 222 patients were analyzed after excluding 4 patients: 3 for revisional surgery and 1 for conversion to open. There were 99 patients in the stapled group and 123 in the handsewn group. In both groups, patients were predominantly female. The average age was 42.63 in the stapled group and 44.33 in the handsewn group (P = 0.218). Body mass index was 48.23 in the stapled group and 47.91 in the handsewn group (P = 0.733). Stricture rate in the stapled group was 10.1% (10/99) and 4.1% (5/123) in the handsewn group (P = 0.076). Four patients from the stapled group (4.08%) and six from the handsewn group (4.88%) needed early reoperation. One patient in each group had a GJ anastomotic leak (0.9%). There were no deaths.
Conclusions
The incidence of anastomotic stricture tends to be lower with a handsewn technique with lower operative time. No difference was appreciated in the anastomotic leak or reexploration rate with either technique.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Steinbrook R (2004) Surgery for severe obesity. N Engl J Med 350:1075–1079
Sjostrom L, Lindross AK, Peltonen M (2004) Lifestyle, diabetes, and cardiovascular risk factors years after bariatric surgery. N Engl J Med 351:2683–2693
Wittgrove AC, Clark GW, Tremblay LJ (1994) Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg 4:353–357
Buchwald H, Avidar Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737
Almahmeed T, Gonzalez R, Nelson LG, Haines K, Gallagher SF, Murr MM (2007) Morbidity of anastomotic leaks in patients undergoing Roux-en-Y gastric bypass. Arch Surg 142:957–964
Ruiz-de-Adana JC, Lopez-Herrero J, Hernandez-Matias A, Colao-Garcia L, Muros-Bayo JM, Bertomeu-Garcia A, Limones-Esteban M (2008) Laparoscopic handsewn gastrojejunal anastomoses. Obes Surg 18:1074–1076
Bohdjalian A, Langer FB, Kranner A, Shakeri-Leidenmuhler S, Zacherl J, Prager G (2010) Circular- vs. linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. Obes Surg 20:440–446
Frutos MD, Lugan J, Garcia A, Hernandez Q, Valero G, Gil J, Parrilla P (2009) Gastrojejunal anastomotic stenosis in laparoscopic gastric bypass with a circular stapler (21 mm): incidence, treatment and long-term follow-up. Obes Surg 19:1631–1635
Mathew A, Veliuona MA, DePalma FJ, Cooney RN (2009) Gastrojejunal stricture after gastric bypass and efficacy of endoscopic intervention. Dig Dis Sci 54:1971–1978
Dolce CJ, Dunnican WJ, Kushnir L, Bendana E, Ata A, Singh TP (2009) Gastrojejunal strictures after Roux-en-Y gastric bypass with a 21-mm circular stapler. JSLS 13:306–311
Ruiz-de-Adana JC, Hernandez-Matias A, Hernandez-Bartolome M, Manzanedo-Romero I, Ledesma RL, Valle-Rubio A, Lopez-Herrero J, Limones-Esteban M (2009) Risk of gastrojejunal anastomotic stricture with multifilament and monofilament sutures after handsewn laparoscopic gastric bypass: a prospective cohort study. Obes Surg 19:1272–1277
Gonzalez R, Lin E, Venkatesh KR, Bowers SP, Smith CD (2003) Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques. Arch Surg 138:181–184
Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J (2000) Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232:515–529
The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium (2009) Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med 361:445–454
Carrodeguas L, Szomstein S, Zundel N, Menzo EL, Rosenthal R (2006) Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass surgery: analysis of 1291 patients. SOARD 2:92–97
Kellum JM, DeMaria EJ, Sugerman HJ (1998) The surgical treatment of morbid obesity. Curr Probl Surg 35:791–858
Maher JW, Hawver LM, Pucci A, Wolfe LG, Meador JG, Kellum JM (2008) Four hundred fifty consecutive laparoscopic Roux-en-Y gastric bypasses with no mortality and declining leak rates and lengths of stay in a bariatric training program. J Am Coll Surg 206:940–945
Gonzalez R, Nelson LG, Gallagher SF, Murr MM (2004) Anastomotic leaks after laparoscopic gastric bypass. Obes Surg 14:1299–1307
Marema RT, Perez M, Buffington CK (2005) Comparison of the benefits and complications between laparoscopic and open Roux-en-Y gastric bypass surgeries. Surg Endosc 19:525–530
American Society for Metabolic, Bariatric Surgery (2009) ASMBS guideline on the prevention and detection of gastrointestinal leak after gastric bypass including the role of imaging and surgical exploration. SOARD 5:293–296
Thodiyil PA, Yenumula P, Rogula T, Gorecki P, Fahoum B, Gourash W, Ramanathan R, Mattar SG, Shinde D, Arena VC, Wise L, Schauer P (2008) Selective nonoperative management of leaks after gastric bypass. Ann Surg 248:782–792
Higa KD, Ho T, Boone KB (2000) Complications of the laparoscopic Roux-en-Y gastric bypass: 1, 040 patients—what have we learned? Obes Surg 10:509–513
Disclosures
Drs. Amanda Kravetz, Subhash Reddy, Ghulam Murtaza, and Panduranga Yenumula have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kravetz, A.J., Reddy, S., Murtaza, G. et al. A comparative study of handsewn versus stapled gastrojejunal anastomosis in laparoscopic Roux-en-Y gastric bypass. Surg Endosc 25, 1287–1292 (2011). https://doi.org/10.1007/s00464-010-1362-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-010-1362-x