A technique of stapled gastrojejunostomy for open gastric bypass results in increased wound complication-rate.
BACKGROUND
Gastric bypass may be facilitated by a stapled gastrojejunostomy. This study compared two different techniques for performing this critical anastomosis in open surgery.


METHODS
67 consecutive patients were retrospectively studied for weight loss, hospital length of stay, anastomotic stricture, wound complication, and incisional hernia. 49 patients had a two layer hand-sutured gastrojejunostomy over a 34 Fr bougie via a laparotomy (sutured). 18 patients had a stapled gastrojejunostomy using the technique of Wittgrove and Clark via a laparotomy (stapled). All patients received prophylactic intravenous antibiotics preoperatively.


RESULTS
Initial BMI, % of excess weight lost at 6 weeks and 6 months, and hospital length of stay were not statistically different between the groups. However, the rate of wound complication and incisional hernia rate were significantly higher in the stapled group when compared to the sutured group (p< 0.01).


CONCLUSIONS
Based on these data we suggest that the technique of Wittgrove and Clark for performing the gastrojejunostomy should not be used in open gastric bypass as it results in increased rates of wound complication and incisional hernia.
Madigan
J D
JD
New York Presbyterian Center for Obesity Surgery, New York, NY, USA.
Morales
D L
DL
Bessler
M
M
D000328:Adult; D005260:Female; D015390:Gastric Bypass; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D007582:Jejunostomy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D013528:Surgical Staplers; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D013530:Surgical Wound Infection / Q000209:etiology*; D015431:Weight Loss