A Comparative Study of Hand-sewn Versus Stapled Gastrojejunal Anastomosis in Laparascopic Roux-en-Y Gastric Bypass

OBJECTIVE: The two basic techniquesavailable in which to perform the gastrojejunal (GJ) anastomosis during a laparoscopic Roux-en-Y gastric bypass are stapled and hand-sewn techniques. Few outcomes differences have been noted between the two in order to recommend one as a superior approach. We present our findings of stricture and leak as potential differences in outcome.
METHODS: This case study is a retrospective review of the first 200 patients to undergo laparoscopic Roux-en-Y gastric bypass at a single institution between the years 2006 and 2009. The GJ anastomosis of the first 100 patients was completed using a linear stapled technique. The next 100 patients had hand-sewn GJ anastomoses and were chosen for comparison. Primary outcomes were the rate of stricture formation requiring esophagogastroduodenoscopy (EGD) with balloon dilatation and GJ anastomotic leak. The diameter of the anastomosis for both the stapled and hand-sewn techniques was 2cm.
RESULTS: A total of 200 patients were analyzed. 85% were female and the average age was 42.67 in the stapled group. 87% were female and the average age was 43.45 in the hand-sewn group (p=0.68 and p=0.67 for gender and age respectively). BMI was 48.06 in the stapled group and 48.01 in the hand-sewn group (p=0.76). The rate of stricture formation in the stapled group was 8% (8/100) and 1% in the hand-sewn group, and this finding was statistically significant with a p value of 0.017. No statistical difference of stricture formation based on age (those younger than versus those older than 40 years) was noted between the two groups (p=0.88 and p=0.32 for the stapled and the hand-sewn anastomoses respectively). The average length of time from the operation to the EGD with balloon dilatation was 40.9 days in the stapled group and 108 days in the hand-sewn group (p=0.004). One patient with a stapled anastomosis required 2 dilatations. Two patients in the stapled group had a GJ anastomotic leak (p=0.16) and did not require eventual dilatation. All patients were followed up for at least 4 months.
CONCLUSION: The incidence of anastomotic stricture is significantly higher with a linear stapled technique compared to a hand-sewn gastrojejunal anastomosis in patients undergoing laparoscopic Roux-en -Y gastric bypass.

Session: Podium Presentation

Program Number: S100