Gwen Bonner, MD, Mohammad Kalantar, MD, Rami Mustafa, MD, Mujjahid Abbas, MD, Leena Khaitan, MD, MPH. University Hospitals Cleveland Medical Center
BACKGROUND: Bariatric surgery is a common procedure in general surgery. Gastric bypass has been performed laparoscopically for over two decades and multiple techniques are described. The circular stapled anastomosis, one of the earliest methods for gastrojejunostomy, is performed in two ways: a transoral method to introduce the anvil and a transabdominal approach developed later. The former technique requires passing the anvil of the circular stapler through the mouth, down the esophagus, and into the gastric pouch. In the latter method, a gastrotomy is made, the anvil is introduced, and the gastrotomy is stapled off, creating the gastric pouch. This study aims to objectively compare the two methods of circular stapled gastrojejunostomy in terms of surgical site infection(SSI) rate.
METHODS: A retrospective chart review of patients undergoing laparoscopic roux-en-y gastric bypass with one of two surgeons at a bariatric center of excellence in an academic hospital from January 1, 2016 through December 31, 2016 was completed. Data regarding surgical technique, patient demographics, and postoperative complications was collected and maintained in a secure database. T-test, chi-square, and X software were used for analyses where appropriate; p<0.05 was considered significant
RESULTS: A single surgeon performed 51 procedures during this time period, exclusively utilizing a transoral approach for the gastrojejunostomy; the other surgeon performed 91 procedures, exclusively utilizing the transabdominal approach. The two groups were similar with regard to patient BMI (45 versus 46 with p-value 0.2) and age (49 versus 46 with p-value 0.26).
Wound complications, including deep and superficial infections as well as seroma formation, were compared between the two groups. With the transoral anastomosis, 3 out of 50 patients formed seromas, 3 out of 50 developed deep infections, and 3 out of 50 had superficial site infections for a rate of 6% each and a total wound complication rate of 18%. In the transabdominal group, 2 out of 91 patients formed seromas, but none developed deep or superficial infections for a total wound complication rate of 2%. This was a statistically significant difference with p-value <0.001.
CONCLUSIONS: At this point in the evolution of the roux-en-y gastric bypass, both the transoral and the transabdominal methods are acceptable; however, our study suggests that the transabdominal approach may result in significantly fewer surgical site infections and overall wound complications. Therefore, the results of this study lead to the conclusion that a transabdominal method of circular stapled gastrojejunostomy is superior.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87726
Program Number: P639
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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