title: Early experience with intraluminal reinforcement of stapled gastrojejunostomy during laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  The use of extraluminal staple-line buttressing material during laparoscopic Roux-en-y gastric bypass has shown the potential to reduce staple-line leak and bleeding. We herein present our early experience with intraluminal reinforcement of linear-cutting stapled gastrojejunal anastomosis with the use of bioabsorbable glycolide copolymer staple-line reinforcement.
  
  
  METHODS
  Laparoscopic Roux-en-Y gastric bypass was performed in 80 consecutive non-randomized morbidly obese patients. Gastrojejunal anastomosis was performed using a linear-cutting stapler without staple-line reinforcement in 40 patients (group A), while in the other 40 patients (group B), gastrojejunostomy was performed using a linear cutting stapler with intraluminal reinforcement material (bioabsorbable glycolide copolymer). Demographic data were collected. The rate of gastrojejunal anastomotic leak, bleeding, and stricture was determined.
  
  
  RESULTS
  There was a statistically significant reduction in bleeding complications between the two groups (15% bleeding in group A vs. no bleeding in group B, P value=0.0255). Stricture rate was higher in-group A (10% group A vs. 2.5% in group B); however, the difference was not statistically significant (P value=0.2007). None of our patients developed a gastrojejunal leak.
  
  
  CONCLUSIONS
  Intraluminal reinforcement of gastrojejunal anastomosis during laparoscopic gastric bypass is safe and feasible. The use of intraluminal bioabsorbable glycolide copolymer staple-line reinforcement significantly reduces the incidence of gastrojejunal bleeding.
authors.affiliation: Minimally Invasive Surgery, Department of Surgery, Michigan State University/Kalamazoo Center for Medical Studies, 1000 Oakland Drive, Kalamazoo, MI 49008, USA. saber@kcms.msu.edu
authors.forename: Alan A
authors.initials: AA
authors.lastname: Saber
authors.forename: Keith R
authors.initials: KR
authors.lastname: Scharf
authors.forename: Ali Z
authors.initials: AZ
authors.lastname: Turk
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Elgamal
authors.forename: Ruvie L M C
authors.initials: RL
authors.lastname: Martinez
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017792:Surgical Stapling / Q000379:methods*