Roux-en-Y Gastric Bypass: Does the Direction of Staples Matter?

Abstract

Purpose

Mechanical gastro-intestinal anastomosis using stapler is a critical step in laparoscopic Roux-en-Y gastric bypass (RYGB). To date the effect of the direction of staples on anastomotic leak has not been investigated. The study aim was to investigate the impact of the direction of staples on the integrity of the gastro-jejunal anastomosis.

Materials and Methods

Eight gastro-jejunostomy (GJ) models were performed using porcine stomach and small intestine. Specimens were divided into group A where the cartridge was in the gastric lumen with the anvil in the jejunal lumen and vice versa in group B. Enterotomy was closed and gastric and jejunal ends were stapled off. Burst pressure (BP) was measured by infusion of methylene blue saline into the GJ model until leak occurred. Site of leak, BP, and total volume (TV) infused were recorded. Compliance (C) was calculated from the equation ΔTV/ΔBP.

Results

The BP was greater in group A compared to group B (18 mmHg (range 15–25) versus 11 mmHg (range 8–15); p = 0.045) despite similar TV between the groups 60.00 mL (range 55.00–65.00) versus 51.25 mL (range 40.00–60.00); p = 0.11). The compliance did not significantly differ between groups A and B (6.38 mL/mmHg (range 4.34–8.59) versus 5.61 mL/mmHg (range 3.93–7.21); p = 0.48).

Conclusion

BP recorded when the stapler cartridge was introduced in the gastric lumen was higher than when it was introduced from the jejunal lumen. The lack of difference in compliance between groups suggests that the difference in BP was due to the difference in the direction of staples.

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Acknowledgments

M.S., A.K. and K.C. were responsible for specimen preparation and processing, data collection and processing. All authors participated in data analysis and manuscript writing. C.L. was responsible of data processing on MatLab®. A.A.T., C.L. and R.S. were responsible for statistical analysis of the results.

A.A.T. is a clinician scientist supported by the National Institute for Health Research (NIHR) in the UK. The views expressed in this publication are those of the author(s) and not necessarily those of the National Health Service, the NIHR or the Department of Health.

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Correspondence to Mohamed Sahloul.

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The authors declare that they have no conflict of interest.

Ethical Approval Statement

All procedures involving animal tissues were in accordance with Heart of England NHS Foundation Trust policy for the use of animal tissues for training/research purposes in accordance with the National Centre for the Replacement Refinement and Reduction of Animals in Research guidelines.

All porcine tissues used in the study were collected and processed in accordance with The Animal By-products Regulations 2005 (Regulation EC no. 142/2011).

All applicable institutional and/or national guidelines for the care and use of animals/animal tissues were followed.

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Sahloul, M., Karim, A., Chohan, K.S. et al. Roux-en-Y Gastric Bypass: Does the Direction of Staples Matter?. OBES SURG 28, 2868–2873 (2018). https://doi.org/10.1007/s11695-018-3275-z

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Keywords

  • Bariatric surgery
  • RYGB
  • Burst pressure
  • Compliance
  • Stapled anastomosis
  • Staple direction
  • Gastro-jejunal
  • Linear stapler