The Impact of Use of a Novel Suture ‘v-loc’ in Roux En Y Gastric Bypass (rygb) in a Recognised Bariatric Centre of Excellence.

Background- Various sutures are employed during anastomotic closure in a RYGB, in an attempt to minimise anastomotic leak which is a major complication, and its consequences on the morbidity and mortality. There remains a concern regarding the efficacy of the sutures. V-loc, an absorbable, uni-directional, secure, barbed, knotless suture has been used in our institution in more than 100 cases. To the best of our knowledge routine use of V-loc in Bariatric surgery has not been reported before.
Aim- to analyse the impact of V-loc suture on the anastomosis and outcome in RYGB.
Method-retrospective analysis of prospectively collected data on operations performed between July 2009 and October 2011. Standard technique was use of single layer, horizontal mattress, Vloc suture (Covidien) to close the gastro-jejunostomy defect, following a stapled Blue 45, (E-Flex, Ethicon), ante-colic, ante-gastric end to side gastro-jejunal anastomosis followed by a methylene blue dye test. Data were analysed for demographics, comorbidites and no. of positive and negative dye test before and after the use of V-loc.
Results- We analysed data on 299 RYGB during the period of study. There were 106 males and 193 females. The median age was 49 (range 22 to 69.).The major co morbidities included 149 diabetics, 122 hypertensives, 113 Obstructive sleep apnoeas and 45 COAD. There were a total of 29 positive dye tests in 194 patients (15%) before Vloc and total of 9 positive dye test in 105 patients (8.5%) after the use of Vloc. Of the 194 patients without Vloc, there were 5 clinically significant leaks, needing surgical or radiological intervention (3.6%) while there was no clinically significant leak (0%) after the use of V-loc. The other major complications included bleeding in 3, infection in 8 and acute gastric dilation in 2 patients. The no of operations were performed by consultant surgeons 216 (72%) while Registrars and Fellows performed 83 (28%) of the operations. The median length of stay was 2 days (Inter-quartile range 2-3 days) and 173 patients (58%) of patients were discharged home within 72 hours. The median weight was 135 (range 92 to 194 Kgs) and the median BMI for the study period was 49 (range 37 to 65). All obstructive sleep apnoea patients were initially managed on HDU.
Conclusion: There is a clinically significant reduction in the number of anastomotic leaks and positive dye test confirming the efficacy and safety of the Vloc sutures in our unit.

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