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Obesity Surgery

, Volume 17, Issue 3, pp 292–297 | Cite as

Anastomotic Leak following Antecolic versus Retrocolic Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity

  • Michael A. Edwards
  • Daniel B. Jones
  • James Ellsmere
  • Ronit Grinbaum
  • Benjamin E. SchneiderEmail author
Research Articles

Background

Laparoscopic Roux-en-Y gastric bypass(LRYGBP) is the most commonly performed operation for the treatment of morbid obesity in the United States. Previous reports suggest that postoperative complications may be influenced by Roux limb orientation (antecolic versus retrocolic), although thisremains controversial. The aim of this study was toanalyze our experience with anastomotic leaks following LRYGBP with an antecolic- versus retrocolicrouted Roux limb.

Methods

During the 2-year period of June 2003 to June 2005, 353 patients underwent a LRYGBP. 135 were antecolic and 218 retrocolic. All cases were performedby one of three bariatric surgeons. The decisionto perform antecolic versus retrocolic LRYGBP was left to the surgeon’s preference. The primary outcome measure was anastomotic leak.

Results

Mean follow-up was 28 weeks. There wereno perioperative deaths. Overall complication rate was 16.9%. 17 gastrojejunal leaks (4.8%) were identified, consisting of 12 intraoperative leaks (3.4%) and 5 postoperative leaks (1.4%). Postoperative gastrojejunal leak rate was higher in the antecolic group (P = 0.04).

Conclusion

Mortality and complication rates were consistent with reported benchmarks on the efficacy and safety of LRYGBP. Our review suggests that anastomotic leak may be more common after antecolic than after retrocolic LRYGBP for morbid obesity. A prospective randomized study is needed to determine whether antecolically-routed Roux limb is an independent predictor for anastomotic leak following LRYGBP.

Key words

Morbid obesity antecolic retrocolic laparoscopic Roux-en-Y gastric bypass complications anastomotic leak 

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References

  1. 1.
    Nguyen NT, Root J, Zainabadi K et al. Accelerated growth of bariatric surgery with the introduction of minimally invasive surgery. Arch Surg 2005; 140: 1198–202.PubMedCrossRefGoogle Scholar
  2. 2.
    Wittgrove AC, Clark W, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: Preliminary report of five cases. Obes Surg 1994; 4: 353–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Bertucci W, Yagedar J, Takahashi A et al. Antecolic laparoscopic Roux-en-Y gastric bypass is not associated with higher complication rates. Am Surg 2005; 71: 735–7.PubMedGoogle Scholar
  4. 4.
    Carrasquilla C, English WJ, Esposito P et al. Total stapled, total intra-abdominal (TSTI) laparoscopic Roux-en-Y gastric bypass: one leak in 1,000 cases. Obes Surg 2004; 14: 613–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Champion JK, Hunt T, DeLisle N. Role of routine intraoperative endoscopy in laparoscopic bariatric surgery. Surg Endosc 2002; 16: 1663–5.CrossRefGoogle Scholar
  6. 6.
    DeMaria EJ, Surgerman HJ, Kellm JM et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 2002; 235: 640–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Fernandez AZ Jr, DeMaria EJ, Tichansky DS et al. Experience in over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc 2004; 18: 193–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Gonazalez R, Nelson LG, Gallagher SF et al. Anastomotic leaks after laparoscopic gastric bypass. Obes Surg 2004; 14: 1299–307.CrossRefGoogle Scholar
  9. 9.
    Hamilton EC, Sims TL, Hamilton TT et al. Clinical predictors of leak after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc 2003; 17: 679–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Higa KD, Ho T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: techniques and 3-year follow-up. J Laparosendosc Adv Surg Tech A 2001; 11: 377–82.CrossRefGoogle Scholar
  11. 11.
    Nguyen NT, Goldman C, Rosenquist CJ et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 2001; 234: 279–91.PubMedCrossRefGoogle Scholar
  12. 12.
    Podnos YD, Jimenez JC, Wilson SE et al. Complications after laparoscopic gastric bypass: Review of 3464 cases. Arch Surg 2003; 138: 957–961.PubMedCrossRefGoogle Scholar
  13. 13.
    Schauer PR, Ikramuddin S, Gourash W et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000; 232: 515–29.PubMedCrossRefGoogle Scholar
  14. 14.
    Ballesta-Lopez C, Poves I, Cabrera M et al. Learning curve for laparoscopic Roux-en-Y gastric bypass with totally hand-sewn anastamosis. Surg Endosc 2005; 19: 519–24.PubMedCrossRefGoogle Scholar
  15. 15.
    Gonzalez R, Lin E, Venkatesh KR et al. Gastrojejenostomy during laparoscopic gastric bypass: analysis of 3 techniques. Arch Surg 2003; 138: 181–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Jones DB, DeMaria E, Provost DA et al. Optimal management of the morbidly obese patient: SAGES appropriateness conference statement. Surg Endosc 2004; 18: 1029–37.PubMedCrossRefGoogle Scholar
  17. 17.
    Korenkov M, Goh P, Yucel N et al. Laparoscopic gastric bypass for morbid obesity with linear gastrojejunostomy. Obes Surg 2003; 13: 360–3.CrossRefGoogle Scholar
  18. 18.
    Shope TP, Cooney RN, McLeod J et al. Early results after laparoscopic gastric bypass: EEA vs GIA stapled gastrojejunal anastamosis. Obes Surg 2003 13: 355–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Gastrointestinal surgery for severe obesity. National Institutes of Health Consensus Development Conference Draft Statement. Obes Surg 1991; 1: 257–65.CrossRefGoogle Scholar
  20. 20.
    Laparoscopic Roux-en-Y gastric bypass. In: Jones DB, ed. Atlas of Minimally Invasive Surgery. Connecticut: Cine-Med 2006: 298–317.Google Scholar
  21. 21.
    Coleman MH, Awad ZT, Pomp A et al. Laparoscopic closure of the Petersen mesenteric defect. Obes Surg 2006; 16: 770–2.PubMedCrossRefGoogle Scholar
  22. 22.
    Livingston EH, Huerta S, Author D et al. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg 2002; 236: 576–82.PubMedCrossRefGoogle Scholar
  23. 23.
    Oliak D, Ballantyne GH, Davies RJ et al. Short-term results of laparoscopic gastric bypass in patients with BMI ≥60. Obes Surg 2002; 12: 643–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y – 500 patients: technique and results, with 3–60 month follow-up. Obes Surg 2000; 10: 233–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Michael A. Edwards
    • 1
  • Daniel B. Jones
    • 2
  • James Ellsmere
    • 3
  • Ronit Grinbaum
    • 4
  • Benjamin E. Schneider
    • 5
    Email author
  1. 1.Assistant Professor of SurgeryMedical College of GeorgiaAugustaUSA
  2. 2.Associate Professor of Surgery, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  3. 3.Therapeutic Endoscopy Fellow, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  4. 4.Surgical Research Fellow, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  5. 5.Instructor in Surgery, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA

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