Buttressing of the EEA stapler during gastrojejunal anastomosis decreases rate of bleeding-related complications for laparoscopic gastric bypass.
BACKGROUND
Bariatric surgery is a well-tolerated and effective treatment for severe obesity. Newer surgical techniques and equipment have improved safety standards surrounding bariatric surgery. In particular, buttressing of the staple line in sleeve gastrectomy has decreased rates of clinically significant postoperative bleeding. The present study investigates the effectiveness of buttressing the circular stapled anastomosis during laparoscopic Roux-en-Y gastric bypass (LRYGB).


METHODS
Academic, accredited hospital.


METHODS
A total of 253 patients undergoing LRYGB at a single academic institution were included in this retrospective study between 2014 and 2015. Buttressing material was used in 125 of these cases. Demographic information was collected from both groups preoperatively. Surgical characteristics were also obtained analyzed using unpaired t or χ2tests.


RESULTS
Patients in both buttressing and nonbuttressing groups were on average 46 years old and predominantly female (79.2% versus 74.2% female, respectively), with a body mass index of approximately 48 kg/m2. Postoperative weight loss did not significantly differ between groups at any time point (buttressing versus nonbuttressing percentage of excess weight loss: 39.5% versus 41.5% at 3 mo, P = .3860; 56.4% versus 56.7% at 6 mo, P = .9341). There were no significant differences for operating time, length of stay, readmissions, or reoperations. Complications due to strictures were found to be lower for the buttressing group (0% buttressing versus 2.3% nonbuttressing, P = .0851). Specific rates of bleeding-related complications were significantly lower for the group in which buttressing was used (0% buttressing versus 3.1% nonbuttressing, P = .0463).


CONCLUSIONS
Buttressing of the gastrojejunal anastomosis during LRYGB significantly reduces bleeding-related complications and increases tolerability of the procedure.
Section of Bariatric and Minimally Invasive Surgery, Stanford University Hospital and Clinics, Stanford, California.
Zachary A
ZA
Ichter
Section of Bariatric and Minimally Invasive Surgery, Stanford University Hospital and Clinics, Stanford, California.
Lindsay
L
Voeller
Section of Bariatric and Minimally Invasive Surgery, Stanford University Hospital and Clinics, Stanford, California.
Homero
H
Rivas
Section of Bariatric and Minimally Invasive Surgery, Stanford University Hospital and Clinics, Stanford, California.
Habib
H
Khoury
Section of Bariatric and Minimally Invasive Surgery, Stanford University Hospital and Clinics, Stanford, California.
Dan
D
Azagury
Section of Bariatric and Minimally Invasive Surgery, Stanford University Hospital and Clinics, Stanford, California. Electronic address: morton@stanford.edu.
John M
JM
Morton
D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D012189:Retrospective Studies; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000379:methods*
Bleeding; Circular stapled anastomosis; Hemorrhage; Laparoscopic gastric bypass