Comparison of Gastrojejunal an astomoses Complications in Roux-En-Y Gastric Bypass Patients: Hand-sewn vs. 25mm Circular Stapler

Richdeep S Gill, MD, PhD, Reid Barker, BSc, Kevin A Whitlock, BSc, Talal Ali, MD, Xinzhe Shi, MPH, Daniel W Birch, MD, Shahzeer Karmali, MD

University of Alberta

Introduction
Roux-en-Y gastric bypass (RYGB) is an effective means to promote marked weight loss in obese individuals, yet much of the procedure is not standardized. One of the major complications of the procedure is the formation of anastomotic leaks at the gastrojejununal (GJ) anastomosis site, which can produce significant morbidities. In this study, we evaluate our experience and compare the rate of GJ complications using hand-sewn and 25mm circular stapler techniques to create the GJ anastomosis during RYGB.

Methods
A retrospective review (2005-2012) was completed for all primary gastric bypass patients with GJ anastomosis creation by either hand-sewn or 25mm circular stapler (Orvill®) techniques at a teaching hospital with a multidisciplinary, publically-funded obesity program.

Results
The chart review yielded 284 patients (hand-sewn RYGB, n=158; 25mm RYGB, n=126). These patients had a mean BMI of 54±10 kg/m2 and 50±7 kg/m2 in the hand-sewn and 25mm groups, respectively. We found 17 leaks within the hand-sewn group (10.8%) compared with 1 leak within the 25mm group (0.8%), P<0.05. Other complications recorded included 20 patients (7.0%) who experienced GJ anastomotic strictures, 12 (4.2%) who experienced small bowel obstructions, and 18 (6.3%) who experienced bleeding at the GJ site. However, there was no statistical difference in the rates of these complications between groups

Conclusion
In conclusion, we observed low rates of GJ anastomotic complications following RYGB overall, with a significant increase in anastomotic leaks in the hand-sewn population when compared to the 25mm population.


Session: Poster Presentation

Program Number: P411

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