title: Stapling Versus Hand Suture for Gastroenteric Anastomosis in Roux-en-Y Gastric Bypass: a Randomized Clinical Trial.
abstract: BACKGROUND
  Different anastomotic techniques have been evaluated during a laparoscopic Roux-en-Y gastric bypass (RYGB); however, no techniques have proven to be better than any other regarding complications and the percentage of weight loss (excess weight loss (%EWL)), and there are few controlled prospective studies to compare them.
  
  
  METHODS
  A randomized, prospective study was conducted in 238 patients undergoing RYGB for morbid obesity between July 2008 and September 2012 to compare the early and late postoperative complications between the two surgical techniques: gastrojejunal hand-sutured anastomosis (HSA) and circular-stapled anastomosis (CSA). Minimum follow-up was 24 months.
  
  
  RESULTS
  The two groups of patients were similar for demographic data and preoperative comorbidities. There were no significant differences between the surgical techniques regarding %EWL at 3, 12, and 24 months. The patients with CSA had a greater frequency of postoperative gastrointestinal bleeding (GIB) (4.2 vs. 0%, p = 0.024) and surgical wound infection (11.1 vs. 3.4%, p = 0.025) than the patients with HSA, with no significant differences in the other early complications. There were no significant differences in either group for late complications (gastrojejunal anastomosis (GJA) stricture, marginal ulcer, GJA perforation, bowel obstruction, and eventration). No significant differences were observed in operative time, rate of reoperation and postoperative length of hospital stay.
  
  
  CONCLUSIONS
  HSA and CSA were techniques with similar safety and effectiveness in our study. HSA had a lower rate of bleeding complications and surgical wound infection, although it does require greater experience in laparoscopic hand suturing.
authors.affiliation: Department of General Surgery, Metabolic Surgery Unit, Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Ctra. Madrid-Cartagena, 30120, El Palmar, Murcia, Spain, israelabellanmorcillo@gmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Abellán
authors.forename: V
authors.initials: V
authors.lastname: López
authors.forename: J
authors.initials: J
authors.lastname: Lujan
authors.forename: J
authors.initials: J
authors.lastname: Abrisqueta
authors.forename: Q
authors.initials: Q
authors.lastname: Hernández
authors.forename: M D
authors.initials: MD
authors.lastname: Frutos
authors.forename: P
authors.initials: P
authors.lastname: Parrilla
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D015897:Comorbidity; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D017792:Surgical Stapling / Q000009:adverse effects / Q000379:methods; D013536:Suture Techniques / Q000009:adverse effects; D013537:Sutures / Q000009:adverse effects; D015431:Weight Loss / Q000502:physiology
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