Technique or technology? Evaluating leaks after gastric bypass

Varban, Oliver A.; Cassidy, Ruth; Sheetz, Kyle H.; Cain-Nielsen, Ann; Carlin, Arthur M.; Schram, Jon L.; Weiner, Matthew; Bacal, Daniel; Stricklen, Amanda; Finks, Jonathan F.

doi:10.1016/j.soard.2015.07.013

Cited by 32 publications

(8 citation statements)

References 27 publications

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“…According to surgeon and center experience, different anastomosis techniques are used in LRYGB (linear or circular staplers, hand-sewn technique) 14 . Despite being mechanical anastomoses technically easier and operatively faster, recent studies have described a lower rate of wound infection and postoperative bleeding in case of hand-sewn anastomoses, with a leak rate comparable to the mechanical ones 2,14,15 . In our series, the overall complications rate was 4.5%, close to that reported in the literature, without difference between 2D and 3D groups 2,16 .…”

Section: ■ Discussionmentioning

confidence: 99%

Three-dimensional laparoscopic Roux-en-Y gastric bypass with totally hand-sewn anastomoses for morbid obesity. A single center experience

et al. 2020

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To assess the impact of three-dimensional (3D) vision use on operative time (OT) in laparoscopic Roux-en-Y gastric bypass (LRYGB) with hand-sewn anastomoses. Methods: We analyzed a prospectively collected database of patients who underwent LRYGB. We included all patients operated on with either 2D or 3D vision. Demographics and clinical characteristics, operative time, hospital stay and 30-day postoperative complications were collected for all patients and analyzed. Results: During the study time, out of 143 patients who underwent LRYGB for morbid obesity, 111 were considered eligible. Seventy-eight patients were operated with 2D vision and 33 patients with 3D vision. Demographics and clinical characteristics were not different among groups. Mean OT was 203±51 and 167±32 minutes in the 2D and 3D groups respectively (p<0.001). Multivariate analyses showed that increasing age and BMI were independently related to prolonged OT, while 3D vision (OR 6.675, 95% CI 2.380-24.752, p<0.001) was strongly associated with shorter OT. Conclusions: The use of 3D vision in LRYGB significantly reduced the OT, though intra-and postoperative complication rates and the length of hospital stay were not affected. Despite its limitations, our study supports the value of 3D vision laparoscopy in bariatric surgery.

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Section: ■ Discussionmentioning

confidence: 99%

Three-dimensional laparoscopic Roux-en-Y gastric bypass with totally hand-sewn anastomoses for morbid obesity. A single center experience

et al. 2020

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“…This is usually an early complication (most commonly within 1 week after surgery). In 2016 Varban et al [ 31 ] published a retrospective analysis of the Michigan Bariatric Surgery Collaborative, including 16,258 patients who underwent RYGB, and reported the following results: according to the univariate analysis, cases with an increased blood transfusion requirement (OR 4.3; 95%CI 1.00-1.01, P=0.0015), conversions from laparoscopic to open surgery (OR 10.00; 95%CI 1.17-85.59; P=0.0356), the use of buttressing material (OR 3.35; 95%CI 1.61-6.99; P=0.0013), and Covidien stapler brand (OR 2.02; 95%CI 1.08-3.76; P=0.0268) were associated with a significantly higher rate of anastomotic leak. Conversely, the use of fibrin sealant over the G-J anastomoses was associated with a significantly lower rate of leaks (OR 0.37; 95%CI 0.17-0.79; P=0.0099).…”

Section: Staple-line Stenosis: Pathogenesis and Preventionmentioning

confidence: 99%

“…Conversely, the use of fibrin sealant over the G-J anastomoses was associated with a significantly lower rate of leaks (OR 0.37; 95%CI 0.17-0.79; P=0.0099). After multivariate analysis, only the use of buttressing material continued to be associated with a higher rate of leaks (OR 8.79; 95%CI 2.49-31.01; P=0.0007), whereas the use of fibrin sealant was associated with a decrease in the likelihood of leaks (OR 0.11; 95%CI 0.03-0.41 P=0.0013) [ 31 ]. Contrary to those results regarding fibrin sealant, Ibele et al , in a retrospective study evaluating 529 patients (429 fibrin sealant group vs. 104 no), found a leak rate of 0.9% vs. 1.9% (P=0.2) [ 32 ].…”

Section: Staple-line Stenosis: Pathogenesis and Preventionmentioning

confidence: 99%

Complications of staple line and anastomoses following laparoscopic bariatric surgery

Silecchia¹,

Iossa²

2017

aog

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With over 600 million people being obese, and given the scientific demonstration of the advantages of surgical treatment, bariatric surgery is on the rise. The promising long-term results in terms of weight loss, and particularly in relation to comorbidities and the control/cure rate, mean that the number of procedures performed in all countries remains high. However, the risk of potentially complex or fatal complications, though small, is present and is related to the procedures per se. This review is a guide for bariatric and/or general surgeons, offering a complete overview of the pathogenesis of anastomosis and staple line following the most common laparoscopic bariatric procedures: sleeve gastrectomy, gastric bypass, and mini-gastric bypass. The review is divided according to the procedure and the complications (leak, bleeding and stenosis), and evaluates all the factors that can potentially improve or worsen the complication rate, representing a “unicum” in the present literature on bariatric surgery.

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“…Technical improvement of gastrointestinal anastomosis is crucial in these types of surgeries, as it determines the complexity, consumption of time, and quality of anastomosis. 1,2 Meanwhile, natural orifice transluminal endoscopic surgery has become highly favored among surgeons. One focus of this evolution is to obviate external abdominal scars.…”

Section: Introductionmentioning

confidence: 99%