Outcomes of linear-stapled versus hand-sewn gastrojejunal anastomosis in laparoscopic Roux en-Y gastric bypass.
BACKGROUND
In laparoscopic Roux en-Y gastric bypass (LRYGB), the gastrojejunal anastomosis (GJA) may be performed using linear-stapled (LS) or completely hand-sewn (HS) techniques. No published study has compared operative and clinical outcomes following LS and HS LRYGB when performed by surgeons beyond the learning curve. This study examined outcomes of both techniques performed by two 'technique-specific' bariatric fellowship-trained surgeons.


METHODS
Data on consecutive primary LRYGB undertaken in two university hospitals were prospectively collected over 28-months and included demographics, co-morbidities, postoperative morbidity, mortality, length of stay (LOS), reoperations, and excess weight loss (EWL). Data were presented as mean ± SD.


RESULTS
There were 366 LRYGB studied (LS = 144 and HS = 222 patients) with 96 % 12-month follow-up. All procedures were completed laparoscopically with no anastomotic leak or mortality. The LS cohort had a lower body mass index (48.3 ± 5.0 vs 53.8 ± 7.1, P < 0.001), greater incidence of diabetes mellitus (P = 0.009) and sleep apnea (P = 0.007). The HS cohort had more patients in Obesity Surgery Mortality Risk Score classes B and C (P = 0.004 and P = 0.01), and shorter operating time (127 ± 30 vs 172 ± 30 min, P < 0.001). There were no differences in LOS, complications, or reoperations. The HS technique was associated with more GJA stenoses requiring endoscopic dilatation (7.7 vs 0 %, P < 0.001). At 12 months, EWL (%) was comparable between the two techniques (LS 71.0 ± 15.5 vs HS 66.5 ± 13.7, P = 0.09).


CONCLUSIONS
When performed by 'technique-specific' surgeons, both LS and HS GJA in LRYGB may be performed safely with no significant differences in morbidity, reoperations, or EWL.
The East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Derby Hospitals NHS Foundation Trust, Uttoxeter Road, Derby, DE22 3NE, UK, sherif.awad@nhs.net.
Sherif
S
Awad
Rachel
R
Aguilo
Sanjay
S
Agrawal
Javed
J
Ahmed
D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D004106:Dilatation; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006801:Humans; D007583:Jejunum / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D061646:Operative Time; D011183:Postoperative Complications; D011446:Prospective Studies; D013270:Stomach / Q000601:surgery; D017792:Surgical Stapling; D013537:Sutures