Gastrojejunal (GJ) stricture is one of the most common late complications after laparoscopic Roux-en-Y gastric bypass (LRYGBP) with a hand-sewn anastomosis. The object of this study was to assess the risk of stricture for two types of resorbable suture (multifilament and monofilament) in a series of LRYGBPs performed by the same surgeon.
Design: Prospective cohort study. The study population consisted of a series of consecutive morbidly obese patients who underwent primary hand-sewn LRYGBP between March 2004 and May 2008 at the University Hospital in Getafe, Madrid, Spain. The study comprised 242 LRYGBPs with a four-layer continuous hand-sewn anastomosis using absorbable 3/0 gauge suture. The suture material was Ethicon Vicryl® multifilament in the first 105 cases and Ethicon Monocryl® monofilament in the following 137 cases. All patients were followed up monthly for the first 6 months and then every 6 months after that.
The mean BMI was 46 ± 4 for the multifilament cohort and 48 ± 6 for the monofilament cohort with no significant difference between the two (p = 0.567). There were no anastomotic leaks, and no cases of marginal ulcer, abscess, abdominal sepsis, deep vein thrombosis, or pulmonary embolism were recorded. No cases required conversion to open surgery, and perioperative mortality was zero. In all, 11 cases of stricture (4.4%) were recorded, 10 in the multifilament suture cohort (9.5%), and only one in the monofilament suture cohort (0.7%; p = 0.001). The odds ratio was 14.3 (95% CI = 1.8–113.4). The mean outpatient follow-up period was 30 months (range = 6–42).
Anastomotic GJ stricture is a common and well-known complication of laparoscopic gastric bypass for morbid obesity. Hand sewing with monofilament suture significantly lowered the frequency of this complication, and hence, monofilament should be the suture material of choice for this suturing technique.
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Laparoscopic Roux-en-Y gastric bypass
Carrodeguas L, Szomstein S, Zundel N, et al. Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass surgery: analysis of 1 291 patients. Surg Obes Relat Dis. 2006;2:92–7.
Goitein D, Papasavas PK, Gagne D, et al. Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2005;19:628–32.
Papasavas PK, Caushaj PF, McCormick JT, et al. Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2003;17:610–4.
Nguyen NT, Stevens CM. Incidence and outcome of anastomotic stricture after gastric bypass. J Gastrointest Surg. 2003;7:997–1003.
Takata MC, Ciovica R, Cello JP, et al. Predictors, treatment and outcomes of gastrojejunostomy stricture after gastric bypass for morbid obesity. Obes Surg. 2007;17:878–84.
Baltasar A. Hand-sewn laparoscopic duodenal switch. Surg Obes Rel Dis. 2007;3:94–6.
Higa KD, Ho T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Tech A. 2001;11(6):377–382.
Ruiz de Adana JC, López-Herrero J, Hernández-Matías A, et al. Laparoscopic hand-sewn gastrojejunal anastomoses. Obes Surg. 2008;18:1074–1076.
Rossi TR, Dynda DI, Estes NC, et al. Stricture dilation after laparoscopic Roux-en-Y gastric bypass. Am J Surg. 2005;189:357–60.
VanHeerden J. Comparison of inflammatory response to polyglytone 6211 and polyglecaprone 25 in a rat model. S Afr Med J. 2005;95:972–4.
Molea G. Comparative study on biocompatibility and absorption times of three absorbable monofilament suture materials: polydioxanone, polyglecaprone 25, glycomer 631. Br J Plastic Surg. 2000;53:137–41.
Blackstone RP, Rivera LA. Predicting stricture in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass: a logistic regression analysis. J Gastrointest Surg. 2007;11:403–9.
Csendes A, Burgos AM, Burdiles P. Incidence of anastomotic strictures after gastric bypass: a prospective consecutive routine endoscopic study 1 month and 17 months after surgery in 441 patients with morbid obesity. Obes Surg. 2009;19:269–73.
The authors declare that the submitted work is their own and that copyright has not been breached in seeking publication. This is an original work whose content has not been submitted to or published in any other journal and has not been presented at any meeting or congress.
The authors declare that they have no conflict of interest or financial involvement with any company or institution, patent rights, consultancy, research funding or speaker’s fees.
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Ruiz de Adana, J.C., Hernández Matías, A., Hernández Bartolomé, M. et al. Risk of Gastrojejunal Anastomotic Stricture with Multifilament and Monofilament Sutures after Hand-Sewn Laparoscopic Gastric Bypass: A Prospective Cohort Study. OBES SURG 19, 1274–1277 (2009). https://doi.org/10.1007/s11695-009-9897-4
- Bariatric surgery
- Laparoscopic Roux-en-Y gastric bypass
- Hand-sewn anastomosis
- Gastrojejunostomy strictures
- Monofilament suture