Introduction: In laparoscopic RYGBP (LRYGBP), construction of the gastrojejunal anastomosis is the most controversial point of the procedure because this is where severe complications can occur. The transoral circular stapled anastomosis (Gagner’s technique) is widely perfomed due to its technical semplicity, but it can lead to esophageal injuries and high wound infection rates. To overcome these problems, we have developed a personal technique of totally intra-abdominal anastomosis involving a device conceived to help the anvil positionement in the gastric pouch. Methods: Patients submitted to LRYGB at our Institution between January 1996 and December 2009 were retrospectively evaluated; the following data were collected: age, sex, weight and BMI, gastrojejunal anastomosis technique, operative time, hospital stay, post-operative complications. Results: Between January 1999 and December 2009, 326 morbid obese patients underwent LRYGBP at our Institution. Among them, 181 (53 males and 128 females) underwent gastrojejunal anastomosis with the totally intra-abdominal technique. Mean age, weight and BMI were 41.1 years, 132.4 kg, and 47.9 kg/m2, respectively. Mean operative time was 185.4 minutes, and mean hospital stay was 5.7 days. Early postoperative complication rate was 1.7%; concerning anastomosis-related complications, leaks rate was 0% and stricture rate was 6.1%. These results compare favourably with our experience with transoral technique: 68 patients underwent LRYGB with the latter; in this group mean age, weight and BMI were 39.7 years (p NS), 126.8 kg (p NS), 46.1 kg/ m2 (p = 0.048). In this group, mean operative time and hospital stay were 186.8 minutes (p NS) and 8.0 days (p = 0.021); early complication rate was 2.9% (p NS); finally, in Gagner’s technique there was a leak rate of 1.5% (p NS) and a stricture rate of 8.8% (p NS). Conclusions: Our results on 181 patients with a totally intra-abdominal gastro-jejunal anastomosis technique, involving a specifically conceived device, compare favourably with results obtained with transoral technique in terms of operative time and anastomosis complication rates. Our technique is in our opinion simple to perform and easy to learn, with the advantage to not involve esophageal passage of the anvil and to reduce wound infection rates.
Personal technique for laparoscopic Roux-en-Y gastric bypass gastro-jejunal anastomosis: experience on 181 patients
SCOZZARI, Gitana;TOPPINO, Mauro;MORINO, Mario
2011-01-01
Abstract
Introduction: In laparoscopic RYGBP (LRYGBP), construction of the gastrojejunal anastomosis is the most controversial point of the procedure because this is where severe complications can occur. The transoral circular stapled anastomosis (Gagner’s technique) is widely perfomed due to its technical semplicity, but it can lead to esophageal injuries and high wound infection rates. To overcome these problems, we have developed a personal technique of totally intra-abdominal anastomosis involving a device conceived to help the anvil positionement in the gastric pouch. Methods: Patients submitted to LRYGB at our Institution between January 1996 and December 2009 were retrospectively evaluated; the following data were collected: age, sex, weight and BMI, gastrojejunal anastomosis technique, operative time, hospital stay, post-operative complications. Results: Between January 1999 and December 2009, 326 morbid obese patients underwent LRYGBP at our Institution. Among them, 181 (53 males and 128 females) underwent gastrojejunal anastomosis with the totally intra-abdominal technique. Mean age, weight and BMI were 41.1 years, 132.4 kg, and 47.9 kg/m2, respectively. Mean operative time was 185.4 minutes, and mean hospital stay was 5.7 days. Early postoperative complication rate was 1.7%; concerning anastomosis-related complications, leaks rate was 0% and stricture rate was 6.1%. These results compare favourably with our experience with transoral technique: 68 patients underwent LRYGB with the latter; in this group mean age, weight and BMI were 39.7 years (p NS), 126.8 kg (p NS), 46.1 kg/ m2 (p = 0.048). In this group, mean operative time and hospital stay were 186.8 minutes (p NS) and 8.0 days (p = 0.021); early complication rate was 2.9% (p NS); finally, in Gagner’s technique there was a leak rate of 1.5% (p NS) and a stricture rate of 8.8% (p NS). Conclusions: Our results on 181 patients with a totally intra-abdominal gastro-jejunal anastomosis technique, involving a specifically conceived device, compare favourably with results obtained with transoral technique in terms of operative time and anastomosis complication rates. Our technique is in our opinion simple to perform and easy to learn, with the advantage to not involve esophageal passage of the anvil and to reduce wound infection rates.
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