TRANS ORAL TECHNIQUE FOR GASTROJEJUNOSTOMY IN LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS CAN EASE LEARNING CURVE AND REDUCE COST
Background: The stapled gastrojejunostomy of the laparoscopic Roux-en-Y gastric bypass (LRYGB) can be created by linear stapling techniques or by a circular stapler. In the circular stapling technique, the anvil of the stapler can be introduced into the pouch trans-abdominally or pulled down the esophagus (trans-orally) by attachment to a modified gastric tube. The purpose of this study is to determine if using the trans-oral technique to pass the anvil will reduce operative time and cost compared with the trans-abdominal technique, which requires creating a new gastrotomy to insert the anvil followed by closure of the gastrotomy.
Methods: We compared 40 consecutive LRYGB procedures performed by the same surgeons; first 20 cases were performed by trans-abdominal anvil insertion, followed by 20 cases using trans-oral anvil insertion. The first 10 trans-oral cases were assisted by fellows in their last month of training and the remaining by fellows in their first month of training. Surgery duration, number of staplers used, and operative costs were compared. Complications (bleeding, leaks, anastomotic strictures, ulcers, wound infections, length of stay) were also evaluated. Data are expressed as mean ± SD.
Results: Both groups were comparable in age, sex, preoperative BMI, and co-morbidities. Mean operative time between the trans-oral and the trans-abdominal technique was not different (168.4 min ± 34.7 and 172.3 ± 21.2 respectively; p= 0.68) even though the first 10 trans-oral cases were assisted by experienced fellows in their last month of training and the next 10 by new fellows. Supply costs per patient were higher for the trans-abdominal technique ($ 3085 ± 249.2) compared with the trans-oral technique ($ 3085 ± 249.2 and $2859.7 ± 48.8 respectively; p: 0.037). The average number of linear staplers used by the trans-oral technique was reduced by 4± 1. Postoperative complications and length of stay were not statistically different.
Conclusions: The trans-oral technique for placing the circular stapler anvil in LRYGB is safe, and appears to have an easier learning curve. Although, operative time for both techniques was not statistically different, there is reduction in the number of staplers used and overall cost.
Program Number: P177