Paul A Severson, MD, FACS, Martin G Perez, MD, Howard McCollister, MD, FACS, Timothy LeMieur, MD, FACS, Shawn Roberts, MD, FACS, Lea Carlson, RNC. Minnesota Institute for Minimally Invasive Surgery
Background: Circular stapled anastomosis for creation of the gastrojejunostomy during Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) has been associated with increased rates of surgical site infection (SSI) which occur primarily at the left upper quadrant port site. Published articles documented SSI rates from 4.5-30%, which led to a shift in pursuing linear stapler anastomosis for the creation of a gastrojejunostomy. SSI rates for linear anastomosis range from 0.6% to 6.9%. In addition, centers continuing to employ circular staplers have recommended additional preventive techniques to further decrease the SSI rate where the oro-gastric tube is removed and the EEA stapler is inserted, which include stapler covers, wound irrigation and wound antibiotics.
Objective: We present a single center, 10 year, consecutive case experience where the gastrojejunal anastomosis was created with a circular stapler without significant increase in surgical site infections (SSI) compared to alternative methods of creating a gastrojejunostomy.
Setting: Cuyuna Regional Medical Center (Minnesota Institute for Minimally Invasive Surgery)
Method: A retrospective review of medical records and NSQIP/MBSAQIP data was performed on patients who underwent primary or revision LRYGB for obesity between 2006-2016. The EEA stapler (with trans-oral anvil) was utilized consecutively by four faculty surgeons and the bariatric fellow. SSI prevention techniques were limited to trocar exchange, avoiding the use of stapler covers and antibiotic wound irrigation. Cases with deep organ infections were excluded. The primary endpoint was infection rate at the left upper quadrant port site where the EEA stapler was used. Surgical site infection (SSI) was defined by ACS NSQIP standards.
Results: A total of 894 LRYGB were documented from 2006-2016. There were 17 superficial wound infections in the left upper quadrant port site where the oro-gastric tube exits and the EEA stapler enters the abdomen. 16/17 infections required incision and drainage with antibiotics, while one was treated with antibiotics alone. The infection rate was calculated at 1.90% (17/894).
Conclusion: The circular EEA stapler, utilized with trans-oral introduction of the anvil, has an infection rate comparable to that quoted in the literature for the linear stapler. This study contradicts previous reports and highlights the need to standardize some technical components of surgery in order to minimize post-operative complications. Additional preventive steps might contribute to increased costs and time without much added benefit of decreasing surgical site infections.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80283
Program Number: P493
Presentation Session: Poster (Non CME)
Presentation Type: Poster