A prospective evaluation of intracorporeal laparoscopic small bowel anastomosis during gastric bypass.
BACKGROUND
We evaluated the safety and feasibility of performing a laparoscopic intracorporeal end-to-side small bowel anastomosis using a stapling technique as part of a Roux-en-Y gastric bypass operation (RYGBP).


METHODS
80 consecutive patients who underwent RYGBP with laparoscopic jejunojejunostomy were evaluated. Operative time and intraoperative and postoperative complications directly related to the jejunojejunostomy anastomosis were recorded.


RESULTS
All 80 laparoscopic jejunojejunostomy procedures were successfully performed without conversion to laparotomy. Mean operative time was longer for the first 40 laparoscopic RYGBP than for the last 40 RYGBP (32+/-18 min vs 21+/-14 min, respectively, p<0.05). Intraoperative complications were staple-line bleeding (2 patients) and narrowing of the anastomosis (1 patient). Postoperative complications were four small bowel obstructions: technical narrowing at jejunojejunostomy site (2 patients), angulation of the afferent limb (1 patient), and food impaction at the jejunojejunostomy anastomosis (1 patient). These four patients underwent successful laparoscopic re-exploration and creation of another jejunojejunostomy proximal to the original anastomosis. There were no small bowel anastomotic leaks. The median time to resuming oral diet was 2 days.


CONCLUSIONS
Laparoscopic jejunojejunostomy as part of the RYGBP operation is a safe and technically feasible procedure. Postoperative small bowel obstruction is a potential complication, which can be prevented by avoiding technical narrowing of the afferent limb.
Nguyen
N T
NT
Department of Surgery, University of California, Davis, Medical Center, Sacramento 95817-1418, USA. ninh.nguyen@ucdmc.ucdavis.edu
Neuhaus
A M
AM
Ho
H S
HS
Palmer
L S
LS
Furdui
G G
GG
Wolfe
B M
BM
D000713:Anastomosis, Roux-en-Y; D005240:Feasibility Studies; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D010535:Laparoscopy; D011446:Prospective Studies; D017792:Surgical Stapling; D013536:Suture Techniques