An Intraoperative Technique to Reduce Superficial Surgical Site Infections in Laparoscopic Roux-en-Y Gastric Bypass Constructed by Circular Stapler

Yang Zhang¹, Oscar K Serrano, MD², W S Melvin, MD, FACS², Diego R Camacho, MD, FACS². ¹Albert Einstein College of Medicine, ²Montefiore Medical Center

Introduction:

Laparoscopic Roux-en-Y Gastric Bypass (LGBP) has been established as one of the most effective treatments for morbid obesity. Surgical site infections (SSI) are the most common complication following LGBP, affecting as many as 12% of patients.

Methods:

We developed an intraoperative technique to reduce superficial SSI (sSSI) during LGBP constructed by circular EEA stapler. Our technique relies on sterile plastic coverage of the EEA stapler, sterile specimen-bag retrieval of the gastrojejunostomy enteric remnant, and Penrose drainage of the port used to introduce the EEA stapler for 24 hours post-operatively. Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program registry, we analyzed our sSSI outcomes before and after implementation of our technique during LGBP performed by a single surgeon between January 2009 and February 2015. We compared the sSSI rate between the two groups taking into consideration patient age, sex, baseline BMI, smoking status, and comorbidities such as diabetes, hypertension, and hyperlipidemia. Chi-Square and multivariate analysis were performed.

Results:

Between January 2009 and February 2015, we performed 486 LGBP. The cohort before implementation of our technique (Group #1) included 164 patients (33.7%) and the cohort after implementation (Group #2) included 322 patients (66.3%).  Both groups were similar in terms of age, sex, smoking status, and rates of diabetes and hyperlipidemia, but differed in BMI (48.3 kg/m2 in #1; 46.1 kg/m2 in #2), operative time (2.44 hours in #1; 1.87 hours in #2) and prevalence of hypertension (37.8% in #1; 48.8% in #2). Hypertension was not a confounder for sSSI (p=0.35). The sSSI rate was 9.15% for Group #1, and 3.42% for Group #2 (p=0.0079). Controlling for BMI and operative time, multivariate analysis revealed a significant reduction in sSSI (odds ratio 2.98 [95% CI 1.33-6.69]) with our technique.

Conclusion:

We describe a reproducible intraoperative technique that significantly reduces sSSI in EEA-constructed LGBP procedures. Our technique has the potential of hastening postoperative recovery and lowering perioperative costs.