Abstract
Purpose
Patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) are at risk of developing strictures of the gastrojejunal anastomosis (GJA). Several variables can affect this, one of which may be the method of anastomosis. Between 2010 and 2014, our institution utilized three different anastomotic techniques for creating the GJA (25 mm end-to-end circular-stapled (CS), linear-stapled (LS), and robotic hand sewn (HS)). Our objectives were to compare the method of GJA relative to the subsequent development of anastomotic stricture.
Methods
We queried our electronic health record for all patients who underwent an upper endoscopy (EGD) after RYGB (2010–2014). Patient charts were retrospectively reviewed for type of GJA, weight loss, complications, interventions, and revisions of the GJA.
Results
In total, 1112 RYGB were performed at our institute, and 17.4% of patients (194/1112) had an upper endoscopy (EGD). Overall, 3.1% (34/1112) were found to have a stricture of the GJA. Patients undergoing a CS, LS, and HS anastomosis had GJA stricture rates of 4.9%, 0.5%, and 1.2% respectively (CS to LS (p < 0.05), p = NS among CS vs. HS, and LS vs. HS). The rate of GJA revision was 1.5%, 0.5%, and 0.1% (p = NS). In patients who had an EGD, excess BMI loss was 57.4%, 64.6%, and 59.2% (p = NS). In patients symptomatic from strictures, excess BMI loss was 69.4%, 83%, and 63.5% respectively (p = NS).
Conclusion
The anastomotic technique for creating of the GJA may impact the formation of strictures. Based on our experience, gastrojejunostomies created with a 2-mm EEA-stapling technique are at higher risk of strictures.
Graphical abstract
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Change history
23 September 2021
A Correction to this paper has been published: https://doi.org/10.1007/s11695-021-05719-w
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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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Naresh Sundaresan MD, B. Amy Hiticas RN, Mariel Sullivan MS, Benedict Y. Hui, MD, Lauren Poliakin, MD, Kyle J. Thompson, PhD, Iain H. McKillop, PhD, Selwan Barbat MD have no conflicts of interest or financial ties to disclose. Timothy S. Kuwada MD is a speaker for BD Bard and WL Gore and a consultant for Medtronic. Keith S. Gersin MD is a speaker for WL Gore and Medtronic, an investor in Standard Bariatrics, and a consultant for GI dynamics. Abdelrahman Nimeri MD is on the speakers’ bureau of Medtronic.
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Key Points
• Circular-stapled anastomoses had greater rates of stricture formation.
• Excess BMI loss was greater in patients that had symptomatic strictures.
• Circular-stapled anastomoses had higher rates of postoperative EGD.
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Sundaresan, N., Hiticas, B.A., Sullivan, M. et al. Gastrojejunal Anastomotic Stricture Following Roux-en-Y Gastric Bypass: an Analysis of Anastomotic Technique at a Single Institution. OBES SURG 31, 4947–4952 (2021). https://doi.org/10.1007/s11695-021-05678-2
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DOI: https://doi.org/10.1007/s11695-021-05678-2