Comparison between open hand-sewn, laparoscopic stapled and laparoscopic computer-mediated, circular stapled gastro-jejunostomies in Roux-en-Y gastric bypass in the porcine model.
BACKGROUND
In this porcine survival model, we compared laparoscopic computer-mediated flexible circular stapled (SurgASSIST) gastro-jejunostomies in Roux-en-Y gastric bypass (RYGBP) to open hand-sewn (HS) and laparoscopic end-to-end (EEA) anastomosis.


METHODS
RYGBP was performed in 15 pigs. Depending on the technique used to create the gastro-jejunostomy, the pigs were divided in 3 groups. In group A, a standard two-layer hand-sewn anastomosis were performed. In group B and C, gastro-jejunostomies using EEA (B) or SurgASSIST (C) were attempted. Operation time, intraoperative technical failure, postoperative anastomotic leakage, and necropsy results were measured.


RESULTS
14 pigs survived surgery. One leakage from the gastro-jejunostomy was detected intraoperatively in group B. There was no evidence of leakage postoperatively from the proximal gastro-jejunostomy in any groups. No statistical difference was found between the groups concerning the operation time or the diameter and degree of healing of the anastomosis.


CONCLUSIONS
We found the SurgASSIST system safe for performing gastro-jejunostomies in laparoscopic RYGBP. There were no anastomotic failures intra- or postoperatively. At necropsy, there was no evidence of anastomotic stricture or delayed healing processes.
Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
Anne
A
Waage
Michel
M
Gagner
Laurent
L
Biertho
Brian P
BP
Jacob
Won-Woo
WW
Kim
Barbara
B
Faife
Nikhilesh
N
Sekhar
Gianmattia
G
del Genio
D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D015390:Gastric Bypass; D005774:Gastrostomy / Q000379:methods*; D007582:Jejunostomy / Q000379:methods*; D010535:Laparoscopy; D017792:Surgical Stapling; D013552:Swine; D014945:Wound Healing