Early experience with computer-mediated flexible circular stapling technique for upper gastrointestinal anastomosis.
BACKGROUND
Creating the proximal anastomosis in laparoscopic biliopancreatic diversion with duodenal switch (LBPD-DS) and Roux-en-Y gastric bypass (LRYGBP) is a critical step in ensuring the success of the procedures. The aim of this study was to assess the safety and efficiency of performing this anastomosis using a flexible, computerized, circular stapling device.


METHODS
We prospectively monitored the use of a newly FDA-approved stapling device (SurgASSIST, Power Medical Intervention) for the construction of the proximal anastomosis by a variety of approaches and reviewed the charts of 10 patients.


RESULTS
We successfully constructed 9 out of 10 proximal anastomoses: 2 gastro-jejunostomies and 7 duodeno-ileostomies, without any signs of leakage. In 2 patients, the stapling technique involved a transpyloric instrumental passage; both were complicated by the difficulty to pass either the flexible scope or the anvil through the narrow pyloric lumen. In 5 patients, the anvil was placed directly through a duodenotomy and no technical problems were encountered. The median time for performing the proximal anastomosis was 19 minutes (range 9-55). There were no postoperative complications in any patients.


CONCLUSIONS
Stapling using the SurgASSIST was feasible and safe for performing laparoscopic anastomoses in bariatric bypass procedures. A duodenotomy for direct placement of the anvil into the postpyloric region seems to be most feasible for duodenoileostomies, while transoral passage of the anvil can be recommended for gastro-jejunostomies. In its current form, we do not recommend transoral placement of the flexible shaft of the SurgASSIST device. Further clinical trials need to be performed for comparison with existing devices.
Waage
Anne
A
Mount Sinai School of Medicine, Department of Surgery, Division of Laparoscopic Surgery, New York, NY 10029, USA.
Gagner
Michel
M
Feng
John J
JJ
D000328:Adult; D000714:Anastomosis, Surgical / Q000295:instrumentation; D015904:Biliopancreatic Diversion; D015390:Gastric Bypass / Q000295:instrumentation; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D017792:Surgical Stapling / Q000295:instrumentation / Q000379:methods*