title: Risk of gastrojejunal anastomotic stricture with multifilament and monofilament sutures after hand-sewn laparoscopic gastric bypass: a prospective cohort study.
abstract: BACKGROUND
  Gastrojejunal (GJ) stricture is one of the most common late complications after laparoscopic Roux-en-Y gastric bypass (LRYGBP) with a hand-sewn anastomosis. The object of this study was to assess the risk of stricture for two types of resorbable suture (multifilament and monofilament) in a series of LRYGBPs performed by the same surgeon.
  
  
  METHODS
  
  
  
  METHODS
  Prospective cohort study. The study population consisted of a series of consecutive morbidly obese patients who underwent primary hand-sewn LRYGBP between March 2004 and May 2008 at the University Hospital in Getafe, Madrid, Spain. The study comprised 242 LRYGBPs with a four-layer continuous hand-sewn anastomosis using absorbable 3/0 gauge suture. The suture material was Ethicon Vicryl multifilament in the first 105 cases and Ethicon Monocryl monofilament in the following 137 cases. All patients were followed up monthly for the first 6 months and then every 6 months after that.
  
  
  RESULTS
  The mean BMI was 46 +/- 4 for the multifilament cohort and 48 +/- 6 for the monofilament cohort with no significant difference between the two (p = 0.567). There were no anastomotic leaks, and no cases of marginal ulcer, abscess, abdominal sepsis, deep vein thrombosis, or pulmonary embolism were recorded. No cases required conversion to open surgery, and perioperative mortality was zero. In all, 11 cases of stricture (4.4%) were recorded, 10 in the multifilament suture cohort (9.5%), and only one in the monofilament suture cohort (0.7%; p = 0.001). The odds ratio was 14.3 (95% CI = 1.8-113.4). The mean outpatient follow-up period was 30 months (range = 6-42).
  
  
  CONCLUSIONS
  Anastomotic GJ stricture is a common and well-known complication of laparoscopic gastric bypass for morbid obesity. Hand sewing with monofilament suture significantly lowered the frequency of this complication, and hence, monofilament should be the suture material of choice for this suturing technique.
authors: Cirugía General y Digestivo, Hospital Universitario de Getafe, Crta Toledo Km 12.5, 28905-Getafe, Madrid, Spain. ruizdeadana@aecirujanos.es
authors: Juan Carlos
authors: JC
authors: Ruiz de Adana
authors: Alberto
authors: A
authors: Hernández Matías
authors: Miguel
authors: M
authors: Hernández Bartolomé
authors: Israel
authors: I
authors: Manzanedo Romero
authors: Raquel
authors: R
authors: Leon Ledesma
authors: Ainhoa
authors: A
authors: Valle Rubio
authors: Julio
authors: J
authors: López Herrero
authors: Manuel
authors: M
authors: Limones Esteban
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000209:etiology; D004146:Dioxanes / Q000009:adverse effects*; D015390:Gastric Bypass; D006801:Humans; D007583:Jejunum / Q000473:pathology* / Q000601:surgery; D010535:Laparoscopy; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011091:Polyesters / Q000009:adverse effects*; D011098:Polyglactin 910 / Q000009:adverse effects*; D013536:Suture Techniques; D013537:Sutures / Q000009:adverse effects*
chemical_list: D004146:Dioxanes; D011091:Polyesters; D011098:Polyglactin 910; C095495:glycolide E-caprolactone copolymer