Decreasing anastomotic and staple line leaks after laparoscopic Roux-en-Y gastric bypass

Abstract

Operative technique, including appropriate staple sizing, staple line reinforcement, handsewn otomy closures, placement of stay sutures, intraoperative leak testing, and placement of fibrin sealant contributed to a lower than expected incidence of ASL after LRYGB in this series.

Comparação da pressão de ruptura da linha de sutura com grampeamento simples, com sobressutura e com reforço biológico: estudo experimental

“…However, several studies are skeptical in regard of the suture line reinforcements, since they are timeconsuming, especially in laparoscopic surgeries. Besides, they can cause tissue rupture in the site where the suture thread penetrates that tissue 13,25 . The materials for reinforcement of staple lines were initially used in thoracic surgery 1 .…”

Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity

“…11 Fortunately, the incidence of ASL is relatively low at 0.4%-5.2%. [11][12][13][14][15] It is pertinent, however, to mention that experience performing LRYGB plays an important role in lowering the ASL rate, with large retrospective series revealing an almost 40% reduction in ASL as the surgeons became more adept using the technique. 9 To this end, as more surgeons across Canada begin to perform LRYGB, appropriate training, mentorship and meticu lous adherence to the details of the operative technique will be important in maintaining a low ASL rate.…”

“…9 To this end, as more surgeons across Canada begin to perform LRYGB, appropriate training, mentorship and meticu lous adherence to the details of the operative technique will be important in maintaining a low ASL rate. 14 Anastomotic leaks occur most frequently at the gastrojejunal anastomosis 12,16 (Fig. 2); therefore, most bari atric surgeons use some method for intraoperatively testing the integrity of this anastomosis, either via instillation of methyl ene blue ( Fig.…”

“…3) through an orogastric tube or insufflation of air via an orogastric tube or flexible gastroscope with the anastomosis submerged. 9,[12][13][14][15] Early recognition of ASL is critical to avoid further adverse outcomes. 9 Unfortunately, a certain degree of ex perience is necessary to make this challenging diagnosis.…”

“…13 The necessity of routine upper gastrointestinal (UGI) contrast studies has been questioned by some groups; [18][19][20] however, such routine testing within the first 24-36 hours postoperatively has been standard practice among many bariatric surgeons. [13][14][15] Early operative management is the mainstay of treatment for ASLs following LRYGB. The operative goals are to confirm and repair the ASL, remove GI contents from the abdominal cavity and place closed suction drains.…”