title: Fewer gastrojejunostomy strictures and marginal ulcers with absorbable suture.
abstract: BACKGROUND
  The upsurge of gastric bypass procedures has been accompanied by an increase in anastomotic strictures and marginal ulcers. According to the reported literature, the gastrojejunostomy strictures in 3-31% and ulcerates in 1-16% of cases. Several anastomotic techniques are used, however no study has specifically addressed whether choice of reinforcing suture affects rates of stricture or ulcer. We reviewed our case series to determine if a protocol change in suture choice altered the incidence of anastomotic strictures and marginal ulcers.
  
  
  METHODS
  We performed a retrospective review of a prospectively collected database for 315 primary Roux-en-Y gastric bypass patients (7/2008 to 3/2008). Nearly all patients had a 25-mm circular stapled anastomosis with an outer suture layer for reinforcement. Before 5/31/06, interrupted permanent suture was used in 231 patients, and after 6/1/06 interrupted absorbable suture was used in 84 patients. We compared overall rates of stricture, marginal ulceration, and aggregate gastrojejunostomy complications between the two suture groups using a proportional hazards model and log-rank statistic. A p-value < 0.05 was used to assign statistical significance.
  
  
  RESULTS
  We found statistically fewer gastrojejunostomy complications in the absorbable suture group (4.7%) than the permanent suture group (19.9%). Subgroup analysis showed that anastomotic strictures were less common in the absorbable suture group, but the difference was short of statistical confirmation. Use of absorbable suture did result in statistically fewer marginal ulcers (2.3%) compared with absorbable suture (13.4%).
  
  
  CONCLUSIONS
  Use of absorbable reinforcing sutures is associated with fewer gastrojejunostomy complications. We recommend absorbable sutures for the outer layer of stapled gastrojejunal anastomoses when performing isolated Roux-en-Y gastric bypass.
authors.affiliation: Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7081, USA.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Vasquez
authors.forename: D
authors.initials: D
authors.lastname: Wayne Overby
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Farrell
mesh_terms: D020341:Absorbable Implants; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015390:Gastric Bypass; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013276:Stomach Ulcer / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017792:Surgical Stapling; D013536:Suture Techniques; D013537:Sutures