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