title: Laparoscopic hand-sewn gastrojejunal anastomoses.
abstract: BACKGROUND
  Reconstruction of the digestive tract during gastric bypass (RYGBP) or biliopancreatic diversion (BPD) involves a mechanical or a hand-sewn gastrojejunal anastomosis. The object of this paper is to assess laparoscopic hand-sewn gastrojejunal anastomoses.
  
  
  METHODS
  A series of morbidly obese patients was treated with RYGBP or BPD with a laparoscopic hand-sewn gastrojejunal anastomosis at the Hospital Universitario de Getafe-Madrid (Spain) between March 2001 and November 2007.
  
  
  RESULTS
  The series comprised 250 patients, with 232 RYGBPs and 18 BPDs performed. The mean BMI was 46 +/- 4. Only a single case of gastrointestinal hemorrhage (0.4%) was recorded, caused by a marginal ulcer in the early postoperative period (day 6). In the late postoperative period, there were two cases of ulcer (0.8%), one complicated by hemorrhage, the other by perforation. There was no anastomotic leak. One patient (0.4%) required reintervention after 48 h because of thermal perforation of the gastric pouch. There were 11 cases of stenosis (4.4%) requiring radiologically or endoscopically guided dilatation, none in the BPD patients. Mean anastomosis time was 40 +/- 15 min. No cases of mortality or abscess, abdominal sepsis, or thromboembolism were recorded. Mean hospital stay was 5.1 +/- 2.4 days.
  
  
  CONCLUSIONS
  Laparoscopic hand-sewn anastomoses are safe and reproducible by surgeons experienced in internal suturing and knot-tying. The technique lengthens operating time, but constant training develops the surgeon's skills, significantly shortening operating time.
authors.affiliation: Cirugia General y Digestivo, Hospital Universitario de Getafe, Carretera Toledo Km. 12.5, Getafe, Madrid, Spain. ruizdeadana@aecirujanos.es
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Ruiz-de-Adana
authors.forename: Julio
authors.initials: J
authors.lastname: López-Herrero
authors.forename: Alberto
authors.initials: A
authors.lastname: Hernández-Matías
authors.forename: Laura
authors.initials: L
authors.lastname: Colao-Garcia
authors.forename: Jose-Manuel
authors.initials: JM
authors.lastname: Muros-Bayo
authors.forename: Agustín
authors.initials: A
authors.lastname: Bertomeu-Garcia
authors.forename: Manuel
authors.initials: M
authors.lastname: Limones-Esteban
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D015904:Biliopancreatic Diversion; D015331:Cohort Studies; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome