A bidirectional stapling technique for laparoscopic small bowel anastomosis.
BACKGROUND
Small bowel anastomoses can present a technical challenge during laparoscopic procedures, particularly gastric bypass procedures. Early small bowel obstruction (SBO) rates associated with such procedures occur in .7%-5.2% of patients. Herein, we describe how a bidirectional stapling technique moves the enterotomy to the center of the anastomosis, decreasing the chances of an afferent limb obstruction.


METHODS
A prospectively collected cohort of 2263 consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass with bidirectional stapling of the small bowel anastomosis was evaluated for early SBO. All patients met the National Institutes of Health criteria for bariatric surgery.


RESULTS
Overall, 3 patients' perioperative courses were complicated by perioperative, early SBO (.13%). These instances were all attributable to intraluminal blood clots and not from inadvertent narrowing of the afferent limb. One was diagnosed on postoperative day 1 by upper gastrointestinal study (UGI); 2 were diagnosed on postoperative day 2 by computed tomography (CT) scan with oral contrast. All 3 patients' complications were managed with a laparoscopic operation.


CONCLUSIONS
The bidirectional stapling technique for small bowel anastomoses, with our modifications, is a rapid, well-tolerated, and effective technique that offers potential advantages over standard laparoscopic anastomotic techniques by reducing perioperative SBO complications.
The DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
Valerie A
VA
Marks
Josefina
J
Farra
Francisco
F
Jacome
Nestor
N
de la Cruz-Muñoz
D000328:Adult; D003287:Contrast Media; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D017792:Surgical Stapling / Q000379:methods*; D014057:Tomography, X-Ray Computed
D003287:Contrast Media
Bidirectional stapling; Laparoscopic Roux-en-Y gastric bypass; Laparoscopic small bowel anastomosis; Perioperative complication; Small bowel obstruction; Stenosis