title: Anastomotic techniques in open Roux-en-Y gastric bypass: primary open surgery and converted procedures.
abstract: BACKGROUND
  Open Roux-en-Y gastric bypass (RYGB) may be chosen because of known widespread adhesions or as a result of conversion during laparoscopic surgery. Although conversions are rare, they occur even in experienced hands. The gastrojejunostomy may be performed with a circular stapler (CS) or a linear stapler (LS) or may be entirely hand sewn (HS). Our aim was to study differences in outcomes regarding the anastomotic techniques utilized in open surgery.
  
  
  METHODS
  Nationwide cohort.
  
  
  METHODS
  Data on open surgery, both primary open and converted procedures from Scandinavian Obesity Surgery Registry were analyzed for the years 2007-2013. Outcomes were assessed through multivariate analysis, adjusting for gender, age, preoperative body mass index, diabetes, conversion, and technique used for the gastrojejunostomy.
  
  
  RESULTS
  CS was the most common method used for primary open RYGB (58%), whereas LS was the most common for converted RYGB (63%). HS was uncommon in both groups. Operative time was shorter for LS than for CS in the primary open RYGB (110±40 min versus 132±46 min; P<.001). Anastomotic leakage rates were similar in primary open RYGB (1.0%-2.4%), but leakage rates for LS in converted procedures was 10.1%, thus higher compared with 2.1% in converted CS patients (P = .02). Odds ratio for leakage was 2.87 (95% confidence interval 1.18-6.97) for LS using CS as a reference when adjusting for variables above.
  
  
  CONCLUSIONS
  LS was associated to increased risk of leakage in patients with conversion from laparoscopic RYGB to open RYGB. Conversion to open surgery was associated to increased risk of leakage. Technique used for the gastrojejunostomy did not affect weight loss.
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. Electronic address: dedholm@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Edholm
authors.affiliation: Department of Surgical Sciences, Örebro University, Örebro, Sweden.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Näslund
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology; D015992:Body Mass Index; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D019106:Postoperative Hemorrhage / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D017792:Surgical Stapling / Q000379:methods; D013548:Sweden; D016896:Treatment Outcome
keywords: Anastomosis; Complications; Gastric bypass; Gastrojejunostomy; Morbid obesity; Stapling technique