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Impacts of Gastrojejunal Anastomotic Technique on Rates of Marginal Ulcer Formation and Anastomotic Bleeding Following Roux-en-Y Gastric Bypass

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Abstract

Background

Marginal ulceration (MU) and bleeding are possible complications following laparoscopic Roux-en-Y gastric bypass (RYGB). Our institution utilizes three techniques for performing the gastrojejunal anastomosis (GJA), providing a means to compare postoperative MU and bleeding as it relates to GJA technique.

Objectives

We sought to analyze the incidence of MU and bleeding between the 25-mm end-to-end anastomosis (EEA) stapler, linear stapler (LS), and robotic hand-sewn (RHS) GJA techniques.

Methods

Electronic health records for all patients who had an upper endoscopy (EGD) after RYGB were queried (2010–2014). Charts were retrospectively reviewed for type of GJA, complications, endoscopic interventions, and smoking and NSAID use.

Results

Out of 1112 RYGBs, the GJA was created using an EEA, LS, or RHS approach in 58.6%, 33.6%, and 7.7% of patients, respectively. 17.4% had an EGD (19.9% EEA, 13.9% LS, and 14.0% RHS). Incidence of MU was 7.3% (9.3% EEA, 4.8% LS, and 5.8% RHS). Rates of EGD and MU were significantly higher after EEA vs. LS GJA (p<0.05). The bleeding rate was 1.5%, [1.1% EEA, 2.1% LS, and 2.3% RHS (p=NS)]. MU within 90 days of RYGB occurred in 4.1%, 0.8%, and 4.7%, respectively (p<0.05 for EEA vs LS only). NSAID and cigarette use were identified in 29.3%, 38.9%, and 60% and 17.2%, 22.2%, and 20%, respectively, for the EEA, LS, and RHS GJA (p=NS).

Conclusion

The method of GJA has an impact on rate of MU formation. A GJA fashioned with a 25-mm EEA stapler tends to have higher rates of EGD and MU.

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Authors and Affiliations

  1. Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, 2630 E 7th St Suite 100, Charlotte, NC, 28204, USA

    Naresh Sundaresan, Benedict Y. Hui, Lauren Poliakin, Selwan Barbat, Timothy S. Kuwada, Keith S. Gersin & Abdelrahman Nimeri

  2. Division of Research, Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Dr #300, Charlotte, NC, 28204, USA

    Mariel Sullivan, Kyle J. Thompson & Iain H. McKillop

  3. Carolinas Medical Center-Mercy, Atrium Health, 2001 Vail Ave, Charlotte, NC, 28207, USA

    B. Amy Hiticas

Authors
  1. Naresh Sundaresan
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  2. Mariel Sullivan
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  3. B. Amy Hiticas
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  4. Benedict Y. Hui
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  11. Abdelrahman Nimeri
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Correspondence to Abdelrahman Nimeri.

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Ethical Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Informed consent does not apply.

Conflict of Interest

Authors 1, 2, 3, 4, 5, 6, 7, and 8 have no conflicts of interest or financial ties to disclose. Author 9 is a speaker for BD Bard and WL Gore and a consultant for Medtronic. Author 10 is a speaker for WL Gore and Medtronic, an investor in Standard Bariatrics, and a consultant for GI dynamics. Author 11 is on the speakers’ bureau of Medtronic.

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Sundaresan, N., Sullivan, M., Hiticas, B.A. et al. Impacts of Gastrojejunal Anastomotic Technique on Rates of Marginal Ulcer Formation and Anastomotic Bleeding Following Roux-en-Y Gastric Bypass. OBES SURG 31, 2921–2926 (2021). https://doi.org/10.1007/s11695-021-05292-2

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  • DOI: https://doi.org/10.1007/s11695-021-05292-2

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