title: The safety of laparoscopic hand-sutured gastrojejunostomy in gastric bypass for the treatment of morbid obesity.
abstract: BACKGROUND
  Laparoscopic Roux-en-Y gastric bypass is the most commonly adopted bariatric procedure. The predominant majority of surgeons construct the anastomoses using stapled techniques. We describe our technique of complete laparoscopically sutured gastrojejunal anastomosis (GJA) and its outcomes.
  
  
  METHODS
  Electronic database was used to collect data retrospectively for patients undergoing laparoscopic gastric bypass at the senior author's bariatric institutions. The results shown represent median (interquartile range).
  
  
  RESULTS
  Between April 2002 and April 2012, 1,754 consecutive patients (78 % female) aged 43 (35-50) years with BMI 51 (44.5-56.7) kg/m(2) underwent laparoscopic gastric bypass (1,679 primary bypasses, 75 revision procedures). All the GJA were hand-sutured. The operative mortality was 0.17 %. Four patients (0.22 %) developed GJA/gastric pouch leak of whom two died, while a further three patients (0.17 %) needed endoscopic dilatation of GJA stricture during the initial 2 years after surgery.
  
  
  CONCLUSIONS
  In the hands of an experienced laparoscopic surgeon, laparoscopic hand-sutured GJA in patients undergoing gastric bypass is safe and effective with very low anastomotic leak and stricture rates.
authors.affiliation: Department of Surgery, Salford Royal Hospital, Stott Lane, Manchester M6 8HD, UK. baburahmed@hotmail.co.uk
authors.forename: Babur
authors.initials: B
authors.lastname: Ahmed
authors.forename: Basil J
authors.initials: BJ
authors.lastname: Ammori
mesh_terms: D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome