Comparison of hand-sewn, linear-stapled, and circular-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass

Frank P. Bendewald, Jennifer N. Choi, Lorie S. Blythe, Don J. Selzer, John H. Ditslear, Samer Mattar

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Background: There is no consensus on the ideal gastrojejunostomy anastomosis (GJA) technique in laparoscopic Roux-en-Y gastric bypass (LRYGB). We reviewed our experience with three GJA techniques (hand-sewn (HSA), linear-stapled (LSA), and 25-mm circular-stapled (CSA)) to determine which anastomosis technique is associated with the lowest early (60-day) anastomotic complication rates. Methods: From November 2004 through December 2009, 882 consecutive patients underwent LRYGB using three GJA techniques: HSA, LSA, and CSA. All patients had a minimum of 2 months follow-up. Records were reviewed for postoperative gastrojejunostomy leak, stricture, and marginal ulcer, and these early complications were classified according to anastomosis technique. Multivariate analysis was performed to determine associations between complications and anastomosis technique. Results: Preoperative demographics, length of hospital stay, and postoperative follow-up did not differ between the three groups. The majority of patients underwent LSA (n=514, 61.6%) followed by HSA (n=180, 21.6%) and CSA (n=140, 16.8%). Using multivariate analysis, there were no statistically significant differences in the rates of leak (LSA 1.0%, HSA 1.1%, CSA 0.0%, p=0.480), stricture (LSA 6.0%, HSA 6.1%, CSA 4.3%, p=0.657), or marginal ulcer (LSA 8.0%, HSA 7.7%, CSA 3.6%, p=0.180). Conclusions: The three techniques can be used safely with a low complication rate. Our data do not identify a superior anastomosis technique.

Original languageEnglish (US)
Pages (from-to)1671-1675
Number of pages5
JournalObesity Surgery
Volume21
Issue number11
DOIs
StatePublished - Nov 2011
Externally publishedYes

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Gastric Bypass
Hand
Peptic Ulcer
Length of Stay
Pathologic Constriction
Multivariate Analysis
Demography

Keywords

  • Anastomoses
  • Bariatric surgery
  • Stapled
  • Technique

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

Cite this

Bendewald, F. P., Choi, J. N., Blythe, L. S., Selzer, D. J., Ditslear, J. H., & Mattar, S. (2011). Comparison of hand-sewn, linear-stapled, and circular-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. Obesity Surgery, 21(11), 1671-1675. https://doi.org/10.1007/s11695-011-0470-6

Comparison of hand-sewn, linear-stapled, and circular-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. / Bendewald, Frank P.; Choi, Jennifer N.; Blythe, Lorie S.; Selzer, Don J.; Ditslear, John H.; Mattar, Samer.

In: Obesity Surgery, Vol. 21, No. 11, 11.2011, p. 1671-1675.

Research output: Contribution to journalArticle

Bendewald, FP, Choi, JN, Blythe, LS, Selzer, DJ, Ditslear, JH & Mattar, S 2011, 'Comparison of hand-sewn, linear-stapled, and circular-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass', Obesity Surgery, vol. 21, no. 11, pp. 1671-1675. https://doi.org/10.1007/s11695-011-0470-6
Bendewald, Frank P. ; Choi, Jennifer N. ; Blythe, Lorie S. ; Selzer, Don J. ; Ditslear, John H. ; Mattar, Samer. / Comparison of hand-sewn, linear-stapled, and circular-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. In: Obesity Surgery. 2011 ; Vol. 21, No. 11. pp. 1671-1675.
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title = "Comparison of hand-sewn, linear-stapled, and circular-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass",
abstract = "Background: There is no consensus on the ideal gastrojejunostomy anastomosis (GJA) technique in laparoscopic Roux-en-Y gastric bypass (LRYGB). We reviewed our experience with three GJA techniques (hand-sewn (HSA), linear-stapled (LSA), and 25-mm circular-stapled (CSA)) to determine which anastomosis technique is associated with the lowest early (60-day) anastomotic complication rates. Methods: From November 2004 through December 2009, 882 consecutive patients underwent LRYGB using three GJA techniques: HSA, LSA, and CSA. All patients had a minimum of 2 months follow-up. Records were reviewed for postoperative gastrojejunostomy leak, stricture, and marginal ulcer, and these early complications were classified according to anastomosis technique. Multivariate analysis was performed to determine associations between complications and anastomosis technique. Results: Preoperative demographics, length of hospital stay, and postoperative follow-up did not differ between the three groups. The majority of patients underwent LSA (n=514, 61.6{\%}) followed by HSA (n=180, 21.6{\%}) and CSA (n=140, 16.8{\%}). Using multivariate analysis, there were no statistically significant differences in the rates of leak (LSA 1.0{\%}, HSA 1.1{\%}, CSA 0.0{\%}, p=0.480), stricture (LSA 6.0{\%}, HSA 6.1{\%}, CSA 4.3{\%}, p=0.657), or marginal ulcer (LSA 8.0{\%}, HSA 7.7{\%}, CSA 3.6{\%}, p=0.180). Conclusions: The three techniques can be used safely with a low complication rate. Our data do not identify a superior anastomosis technique.",
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T1 - Comparison of hand-sewn, linear-stapled, and circular-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass

AU - Bendewald, Frank P.

AU - Choi, Jennifer N.

AU - Blythe, Lorie S.

AU - Selzer, Don J.

AU - Ditslear, John H.

AU - Mattar, Samer

PY - 2011/11

Y1 - 2011/11

N2 - Background: There is no consensus on the ideal gastrojejunostomy anastomosis (GJA) technique in laparoscopic Roux-en-Y gastric bypass (LRYGB). We reviewed our experience with three GJA techniques (hand-sewn (HSA), linear-stapled (LSA), and 25-mm circular-stapled (CSA)) to determine which anastomosis technique is associated with the lowest early (60-day) anastomotic complication rates. Methods: From November 2004 through December 2009, 882 consecutive patients underwent LRYGB using three GJA techniques: HSA, LSA, and CSA. All patients had a minimum of 2 months follow-up. Records were reviewed for postoperative gastrojejunostomy leak, stricture, and marginal ulcer, and these early complications were classified according to anastomosis technique. Multivariate analysis was performed to determine associations between complications and anastomosis technique. Results: Preoperative demographics, length of hospital stay, and postoperative follow-up did not differ between the three groups. The majority of patients underwent LSA (n=514, 61.6%) followed by HSA (n=180, 21.6%) and CSA (n=140, 16.8%). Using multivariate analysis, there were no statistically significant differences in the rates of leak (LSA 1.0%, HSA 1.1%, CSA 0.0%, p=0.480), stricture (LSA 6.0%, HSA 6.1%, CSA 4.3%, p=0.657), or marginal ulcer (LSA 8.0%, HSA 7.7%, CSA 3.6%, p=0.180). Conclusions: The three techniques can be used safely with a low complication rate. Our data do not identify a superior anastomosis technique.

AB - Background: There is no consensus on the ideal gastrojejunostomy anastomosis (GJA) technique in laparoscopic Roux-en-Y gastric bypass (LRYGB). We reviewed our experience with three GJA techniques (hand-sewn (HSA), linear-stapled (LSA), and 25-mm circular-stapled (CSA)) to determine which anastomosis technique is associated with the lowest early (60-day) anastomotic complication rates. Methods: From November 2004 through December 2009, 882 consecutive patients underwent LRYGB using three GJA techniques: HSA, LSA, and CSA. All patients had a minimum of 2 months follow-up. Records were reviewed for postoperative gastrojejunostomy leak, stricture, and marginal ulcer, and these early complications were classified according to anastomosis technique. Multivariate analysis was performed to determine associations between complications and anastomosis technique. Results: Preoperative demographics, length of hospital stay, and postoperative follow-up did not differ between the three groups. The majority of patients underwent LSA (n=514, 61.6%) followed by HSA (n=180, 21.6%) and CSA (n=140, 16.8%). Using multivariate analysis, there were no statistically significant differences in the rates of leak (LSA 1.0%, HSA 1.1%, CSA 0.0%, p=0.480), stricture (LSA 6.0%, HSA 6.1%, CSA 4.3%, p=0.657), or marginal ulcer (LSA 8.0%, HSA 7.7%, CSA 3.6%, p=0.180). Conclusions: The three techniques can be used safely with a low complication rate. Our data do not identify a superior anastomosis technique.

KW - Anastomoses

KW - Bariatric surgery

KW - Stapled

KW - Technique

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