Elsevier

Surgery for Obesity and Related Diseases

Volume 6, Issue 1, January–February 2010, Pages 64-67
Surgery for Obesity and Related Diseases

Original article
Effect of circular staple line buttressing material on gastrojejunostomy failure in laparoscopic Roux-en-Y gastric bypass

Presented in part at the 2009 Association of Academic Surgery Congress, Fort Myers, Florida
https://doi.org/10.1016/j.soard.2009.05.006Get rights and content

Abstract

Background

To determine the effect of bovine pericardium strip (BPS) reinforcement of the circular stapler on the gastrojejunostomy leak rates and staple line failure after laparoscopic Roux-en-Y gastric bypass (LRYGB) at a university hospital in the United States. Gastrojejunostomy leak after LRYGB is a devastating complication. Various techniques, including buttressing the gastrojejunostomy staple line with biomaterial, have been used in an effort to minimize leaks.

Methods

A total of 350 consecutive patients underwent LRYGB without staple line buttressing. After this initial experience, BPS reinforcement of the gastrojejunostomy was conducted in 81 consecutive patients. BPS reinforcement was not used for the final 69 consecutive patients in this 500 patient series. Circular staple line failures (intraoperative immediate and complete failure of the anastomosis) and leaks were evaluated retrospectively.

Results

Three leaks (and no intraoperative staple line failures) occurred in 419 patients without BPS buttressing, all in the first 100 cases of our experience, and 3 leaks and an anastomotic staple line failure occurred in the 81 patients with BPS buttressing (.7% versus 4.9%, P = .02). The body mass index and other potential leak risk factors did not differ between the 2 groups.

Conclusion

In our experience, buttressing of the circular staple line with BPS during LRYGB was associated with an increased staple line adverse event rate. BPS buttressing of the gastrointestinal circular staple lines should be used with caution.

Section snippets

Methods

From July 2002 to April of 2008, 500 consecutive patients underwent LRYGB performed by the same 2 surgeons in a bariatric surgery program. In our initial experience, the gastrojejunostomy was created using a nonbuttressed circular stapler. After 350 cases, we began to incorporate nonabsorbable buttressing material (Peri-Strips Dry with Veritas Collagen Matrix, Synovis Surgical Innovations, St. Paul, MN) on each side of the circular stapler. This was done for 81 consecutive cases. In the most

Results

A total of 350 consecutive patients underwent LRYGB without circular staple line buttressing of the gastrojejunostomy during a 4-year period. A subsequent group of 81 consecutive patients underwent LRYGB with BPS buttressing of the gastrojejunostomy within an 18-month period. BPS buttressing of the gastrojejunostomy was subsequently abandoned for an additional 69 patients who underwent LRYGB during the next 12 months. Patients who received BPS buttressing were slightly younger than those who

Discussion

Leakage at the site of the gastrojejunostomy is a serious complication of LRYGB that can result in considerable morbidity and mortality. The incidence of leak has been reported to be anywhere from <1% to >5% [1], [2], [10]. A variety of patient and technical factors have been found to increase the risk of anastomotic leak. The increased leak rates have been associated with patient age, male gender, and body mass index >50 kg/m2 at surgery [9], [11], [12], [13]. Technical factors such as staple

Conclusion

In our experience, the use of BPS buttressing material in the circular stapled gastrojejunostomy for LRYGB was associated with an increased incidence of gastrojejunostomy technical complications. Ours is the only series to specifically examine the effect of BPS material on circular staple line leaks in clinical practice. We believe it is possible that the animal and clinical data published examining the effect of buttressing material on gastrointestinal staple lines might not apply to this

Disclosures

The authors claim no commercial associations that might be a conflict of interest in relation to this article.

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