Skip to main content
SpringerLink
Log in

Stapling Versus Hand Suture for Gastroenteric Anastomosis in Roux-en-Y Gastric Bypass: a Randomized Clinical Trial

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Different anastomotic techniques have been evaluated during a laparoscopic Roux-en-Y gastric bypass (RYGB); however, no techniques have proven to be better than any other regarding complications and the percentage of weight loss (excess weight loss (%EWL)), and there are few controlled prospective studies to compare them.

Methods

A randomized, prospective study was conducted in 238 patients undergoing RYGB for morbid obesity between July 2008 and September 2012 to compare the early and late postoperative complications between the two surgical techniques: gastrojejunal hand-sutured anastomosis (HSA) and circular-stapled anastomosis (CSA). Minimum follow-up was 24 months.

Results

The two groups of patients were similar for demographic data and preoperative comorbidities. There were no significant differences between the surgical techniques regarding %EWL at 3, 12, and 24 months. The patients with CSA had a greater frequency of postoperative gastrointestinal bleeding (GIB) (4.2 vs. 0 %, p = 0.024) and surgical wound infection (11.1 vs. 3.4 %, p = 0.025) than the patients with HSA, with no significant differences in the other early complications. There were no significant differences in either group for late complications (gastrojejunal anastomosis (GJA) stricture, marginal ulcer, GJA perforation, bowel obstruction, and eventration). No significant differences were observed in operative time, rate of reoperation and postoperative length of hospital stay.

Conclusions

HSA and CSA were techniques with similar safety and effectiveness in our study. HSA had a lower rate of bleeding complications and surgical wound infection, although it does require greater experience in laparoscopic hand suturing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass for morbid obesity and related comorbidities: a meta-analysis of 21 studies. Zhang Y, Ju W, Sun X et al. Obes Surg. 2014.

  2. Ruiz-de-Adana JC, López-Herrero J, Hernández-Matías A, et al. Laparoscopic hand-sewn gastrojejunal anastomoses. Obes Surg. 2008;18:1074–6.

    Article  PubMed  Google Scholar 

  3. Gonzalez R, Lin E, Venkatesh KR, et al. Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques. Arch Surg. 2003;138:181–4.

    Article  PubMed  Google Scholar 

  4. Lee S, Davies A, Bahal S et al. Comparison of gastrojejunal anastomosis techniques in laparoscopic Roux-en-Y gastric bypass: gastrojejunal stricture rate and effect of subsequent weight loss. Obes Surg. 2014 [Epub ahead of print].

  5. Madan AK, Harper JL, Tichansky DS. Techniques of laparoscopic gastric bypass: on line survey of American society of bariatric surgery practicing surgeons. Surg Obes Relat Dis. 2008;4:166–73.

    Article  PubMed  Google Scholar 

  6. Bandewald FP, Choi JN, Blythe LS, et al. Comparison of hand-sewn, lineal-stapled and circular-stapled gastrojejunostomy in laparoscopic Roux-en-Y Gastric bypass. Obes Surg. 2011;21:1671–75.

    Article  Google Scholar 

  7. Abdel-Galil E, Sabry AA. Laparoscopic Roux-en-Y gastric bypass evaluation of three different techniques. Obes Surg. 2002;12:639–42.

    Article  PubMed  Google Scholar 

  8. Luján JA, Frutos MD, Hernández Q, et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a randomized prospective study. Ann Surg. 2004;239:433–7.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Lujan JA, Frutos MD, Hernández Q, et al. Experience with the circular stapler for the gastrojejunostomy in laparoscopic gastric bypass (350 cases). Obes Surg. 2005;15:1096–102.

    Article  PubMed  Google Scholar 

  10. Shope TR, Cooney RN, McLeod J, et al. Early results after laparoscopic gastric bypass: EEA vs GIA stapled gastrojejunal anastomosis. Obes Surg. 2003;13:355–59.

    Article  PubMed  Google Scholar 

  11. Ahmed B, Ammori BJ. The safety of laparoscopic hand-sutured gastrojejunostomy in gastric bypass for the treatment of morbid obesity. Obes Surg. 2013;23:1487–92.

    Article  PubMed  Google Scholar 

  12. Penna MBBS, Markar S, Venkat V, et al. Lineal-stapled versus circular-stapled laparoscopic gastrojejunal anastomosis in morbid obesity: meta-analysis. Surg Laparosc Endosc Percutan Tech. 2012;22:95–101.

    Article  PubMed  Google Scholar 

  13. Miller KA, Pump A. Use of bioabsorbable staple reinforcement material in gastric bypass: a prospective randomized clinical trial. Surg Obes Relat Dis. 2007;4:417–21.

    Article  Google Scholar 

  14. Wittgrove A, 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.

    Article  CAS  PubMed  Google Scholar 

  15. Kravetz A, Reddy S, Murtaza G, et al. A comparative study of handsewn versus stapled gastrojejunal anastomosis in laparoscopic Roux en Y gastric bypass. Surg Endosc. 2011;25:1287–92.

    Article  PubMed  Google Scholar 

  16. de Adana JC R, Hernández A, Hernández 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. 2009;19:1274–77.

    Article  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. Gould JC, Garren M, Boll V, et al. The impact of circular stapler diameter on the incidence of gastrojejunostomy stenosis and weight loss following laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2006;20:1017–20.

    Article  PubMed  Google Scholar 

  19. Sacks BC, Mattar SG, Qureshi FG, et al. Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic Roux en Y gastric bypass. Surg Obes Relat Dis. 2006;2:11–6.

    Article  PubMed  Google Scholar 

  20. D’Hondt MA, Pottel H, Devriendt. Can a short course of prophylactic low-dose proton pump inhibitor therapy prevent stomal ulceration after laparoscopic Roux en Y gastric bypass? Obes Surg. 2010;20:595–9.

    Article  PubMed  Google Scholar 

  21. Sasse KC, Ganser J, Kozar M, et al. Seven cases of gastric perforation in Roux-en-Y gastric bypass patients: what lessons can we learn. Obes Surg. 2008;18:530–4.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

The authors declare that there are no conflicts of interest

Author Contribution

Israel Abellán and Victor López: study design, data acquisition, and manuscript drafting; J. Abrisqueta, MD. Frutos, and Q. Hernández: data acquisition and manuscript drafting; Juan Luján: data acquisition, manuscript drafting, and statistical analysis; and P. Parrilla: data acquisition, manuscript drafting, and revision.

Author information

Authors and Affiliations

  1. Department of General Surgery, Metabolic Surgery Unit, Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Ctra. Madrid-Cartagena, 30120, El Palmar, Murcia, Spain

    I. Abellán, V. López, J. Lujan, J. Abrisqueta, Q. Hernández, M. D. Frutos & P. Parrilla

Authors
  1. I. Abellán
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. López
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Lujan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Abrisqueta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Q. Hernández
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. D. Frutos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Parrilla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. Abellán.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abellán, I., López, V., Lujan, J. et al. Stapling Versus Hand Suture for Gastroenteric Anastomosis in Roux-en-Y Gastric Bypass: a Randomized Clinical Trial. OBES SURG 25, 1796–1801 (2015). https://doi.org/10.1007/s11695-015-1638-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-015-1638-2

Keywords

Search

Navigation