• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Descriptions and Video Updates
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • COVID-19 Announcements
    • SAGES 2020 Meeting Information
    • 2021 Scientific Session Call For Abstracts
    • 2021 Emerging Technology Session Call For Abstracts
    • 2018 Prevent BDI Consensus Conference
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • Leadership Development and Health Policy Conference Videos
      • SAGES Quality Summit Meeting
      • SAGES 2019
      • SAGES 2018
      • SAGES 2017
      • SAGES 2016
      • SAGES 2015
      • SAGES 2014
      • SAGES 2013
    • Related Meetings Calendar
  • Membership
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • COVID-19 Annoucements
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • Troubleshooting Guides
  • Education
    • SAGES.TV Video Library
    • Virtual Hernia Clinic
    • The SAGES Safe Cholecystectomy Program
    • The Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • The SAGES HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Endorsed Courses
    • SAGES Robotics Fellows Courses
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Educational Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES Quality Initiative
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Research Opportunities
    • SAGES Endorsed Courses
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
    • Fellowship Certification
  • Search
    • COVID-19 Announcements
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Blog
    • All Blog Posts
    • COVID-19
    • Notes from the Battlefield
    • A (Positive) Way Forward
    • President Posts
  • Log In

The Optimal Technique of Gastrojejunostomy in Laparoscopic Gastric Bypass May Be a Hand Sewn Anastomosis. Comparison of Outcomes and Costs.

Piotr Gorecki, MD FACS, Krystyna Kabata, PA, Srikanth Eathiraju, MD, Suraj Parekh, MD, Anthony Tortolani, MD. NEW YORK METHODIST HOSPITAL

 

Introduction: Creation of gastrojejunostomy during laparoscopic gastric bypass remains technically challenging part of the procedure. The techniques utilized include: circular stapled anastomosis (CSA), linear stapled anastomosis (LSA), and hand sewn anastomosis (HSA). No consensus on optimal technique exists and individual surgeon’s training and personal preferences are main determinants behind the choice of method.

Methods: We compare the outcomes of 434 consecutive patients who underwent a CSA with 218 consecutive patients who underwent HSA. All patients were approached with laparoscopic technique and were performed by the same surgeon (PG) at a single institution (NYMH). All patients followed the same clinical pathways for perioperative care. All data were collected and entered into the data base prospectively. The two groups were compared for the following patient variables: mean preoperative weight, BMI, age, sex, insurance status and number of comorbidities.

Main outcome measures: Perioperative outcomes included: operative times, intra-operative blood loss, length of hospital stay and utilization of post discharge prescription pain medications. Complications included mortalities, anastomotic leaks, wound infections, incisional hernias, GI bleeding, 30-day reoperations and anastomotic strictures. Hospital costs were calculated based on a sample of the most recent 100 consecutive patients in each technique group. Financial information included: costs of disposable instrumentation, total hospital charges and hospital charges to reimbursement ratio. The dynamics of postoperative weight and BMI loss were also evaluated. Pearson Chi-Square and t-test were utilized for statistical analysis.

Results: Groups were comparable preoperatively (mean BMI in CSA group 48.34 vs. 47.61 in HSA group, p=0.178). All operations were completed laparoscopicaly and there were no major intraoperative complications and no intraoperative blood transfusions in either group. There was a shorter operating time in the HSA group (HSA group, 150.87 min vs. CSA group, 179.89 min, p<0.001) and less blood loss in the HSA group (17.19 cc vs. 44.95 cc.). Patients in the HSA group had shorter mean hospital stay (2.47 vs.3.45 days, p<0.001) and less utilization of prescription pain medications (2.84 vs. 7.43 days, p<0.001). There was no postoperative mortality and no leaks in the HSA group (3 leaks in CSA group). There were no wound infections in HSA group (HSA 0% vs. CSA, 17 patients, 3.92%), and no postoperative GI hemorrhage in HSA group (0% vs.3.7%). There were 8 (1.84%) 30-day reoperations in CSA group (5-laprotomy, 3- laparoscopy, 7 potentially related to utilization of staple products) and 3 reoperations (1.36%) in the HSA group (all 3 – laparoscopy, none related to HSA technique). The incidence of anastomotic strictures was similar in both groups (HSA 5.5% vs. 6.9% in CSA group). HSA provided significant costs saving ($1004.03 saving in disposable instrumentation per patient) and 33.06% improvement in hospital charges to reimbursement ratio. The dynamics of weight loss, and 1-year excess weight loss were similar in both groups (1 year BMI 31.27 in CSA vs. BMI 31.69 in HSA, p=0.483)

Conclusions: HSA appears to be a less expensive and safer method as compared to CSA and therefore may be the preferred technique of laparoscopic gastrojejunostomy during laparoscopic gastric bypass.
 


Session Number: Poster – Poster Presentations
Program Number: P496
View Poster

Post Views: 492

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2012 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Daniel Herron, MD

An opportunity to slow down and appreciate the small joys in life

Dan Herron, MD shares insights with Dana Telem, MD on lessons learned from COVID-19 Fear, anxiety and uncertainty has dominated the first half of 2020. Never before have we, as healthcare providers, been asked to do so much with so little—whether it’s resources like personal protective equipment, dusting off skills related to critical care, or […]

covid testing stock

Notes from the Battlefield – May 14, 2020

Coronavirus Global Surgical Collaborative (CVGSC)* An initiative sponsored by SAGES in collaboration with EAES, AEC, KSELS, and ELSA A group of surgical leaders from affected countries have joined to discuss what they are learning during this Covid-19 Global crisis. The following is a brief summary of what they feel may be useful information to disseminate to the surgical […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Newsletter Subscription

  • This field is for validation purposes and should be left unchanged.

Important Links

SAGES 2020 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

[footer_backtotop] · Log in

Copyright © 2021 Society of American Gastrointestinal and Endoscopic Surgeons · Legal
· Managed by BSC Management, Inc