Stricture Rates After Gastric Bypass With Hand Sewn Anastomosis

Javier J Flores, BS. Providence Memorial Hospital

Background: Anastomotic strictures at the gastrojejunal anastomosis are relatively common after a gastric bypass. There are three different ways to perform a gastrojejunal(GJ) anastomosis; circular stapled, linear stapled and hand sewn. The circular stapled technique obviously provides the most standard diameter and the other two techniques can be standardized by using a bougie to calibrate the diameter of the anastomosis. However they all have the possibility to stricture. This requires a dilation, whether pneumatic or with a tapered dialator. This study examines the stricture rate of a hand sewn GJ over a 4 year period and evaluates potential contributing factors.

Methods: A prospectively maintained database was used to retrospectively evaluate patient outcomes at our bariatric center. This included data on complications. This database was evaluated for strictures. The gastric bypasses were performed over a 4 year period by a single surgeon. The technique remained standard over the study period. This was a 2 layered hand sewn anastomosis with 4 different sutures of 2.0 Vicryl. The patients chart was then examined for radiographic studies, endoscopies, treatment and outcomes. Patient characteristics were also evaluated. Inclusion criteria were primary laparoscopic gastric bypasses. Exclusion criteria were revisions, conversions to open procedures and combined procedures.

Results: In the period from 2010-2013 there were 418 primary laparoscopic gastric bypasses. The overall stricture rate was 3.3% with 14 patients. This varied by year from a low of 2.4% in 2010 to 6.7% in 2011. The average time to stricture was 57.5 days with a standard deviation of 28.5. All patients responded to pneumatic dilation.

Conclusions: A two layered hand sewn anastomosis has an acceptable rate of stricture. These strictures are early and respond well to pneumatic endoscopic dilation.

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