title: A biodegradeable membrane from porcine intestinal submucosa to reinforce the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass: preliminary report.
abstract: BACKGROUND
  A Silastic ring has been used to prevent dilation of the gastrojejunostomy in Roux-en-Y gastric bypass (RYGBP). The use of a bio-membrane may prevent dilation of the anastomosis without the risks associated with prostheses. The aim of this study was to evaluate the feasibility and safety of applying such a bio-membrane around the gastrojejunostomy in Laparoscopic RYGBP (LRYGBP).
  
  
  METHODS
  We used a new bio-membrane, that is derived from porcine small intestinal submucosa (SIS) and acts as a scaffolding for the ingrowth of connective tissue. Over a 4-month period, 14 LRYGBP patients had their proximal anastomosis wrapped with 10 x 2.5 cm SIS by a single surgeon. We compared these patients to a control group of LRYGBP patients matched for BMI.
  
  
  RESULTS
  The average age of the patients was 35.0 years (control group: 45.1 years). The patients had a mean initial BMI of 44.7 kg/m2 (+/- 5.9) standard error, and the control subjects had a mean initial BMI of 46.7 kg/m2 (+/- 6.5). SIS application took a mean time of 11 (+/- 3) minutes without any intraoperative complication. The median hospital stay was 3.5 days in the experimental group and 3.7 days in controls. Three patients developed a symptomatic stenosis at the gastrojejunostomy following surgery. In the control group there were two stenoses. At an average follow-up of 87 days (controls: 95 days), the mean reduction in BMI was 7.8 (+/- 0.8) kg/m2 [controls 8.6 kg/m2 (+/- 1.5)].
  
  
  CONCLUSIONS
  Application of SIS around the gastrojejunostomy in patients undergoing LRYGBP is feasible and safe. Further follow-up is required, however, to evaluate the effectiveness in preventing dilation of the anastomosis.
authors.affiliation: Division of Laparoscopic Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Kini
authors.forename: M
authors.initials: M
authors.lastname: Gagner
authors.forename: J
authors.initials: J
authors.lastname: de Csepel
authors.forename: P
authors.initials: P
authors.lastname: Gentileschi
authors.forename: G
authors.initials: G
authors.lastname: Dakin
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods*; D000818:Animals; D001673:Biodegradation, Environmental; D001684:Biological Dressings / Q000009:adverse effects / Q000592:standards*; D015992:Body Mass Index; D003251:Constriction, Pathologic / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007413:Intestinal Mucosa / Q000637:transplantation*; D007582:Jejunostomy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D013270:Stomach / Q000473:pathology; D013552:Swine; D016896:Treatment Outcome; D015431:Weight Loss; D014945:Wound Healing