Stricture Rates After Gastric Bypass with Hand-Sewn Anastomosis

Abstract

Background:

Anastomotic strictures at the gastrojejunal anastomosis (GJA) are relatively common after a laparoscopic Roux-en-Y gastric bypass (LRYGB). There are three different ways to perform a GJA: circular stapled (CS), linear stapled (LS), and hand-sewn (HS). The CS technique provides the most standard diameter, and the LS and HS techniques can be standardized by using a bougie to calibrate the diameter of the anastomosis. However, they can all become strictured. This study examines the stricture rate of a hand-sewn GJA over a 4-year period.

Methods:

A prospectively maintained database was used to retrospectively evaluate patient outcomes at our bariatric center. This database was evaluated for strictures. The gastric bypasses were performed over a 4-year period by a single surgeon. The technique remained standard over the study period. This was a two-layered HS anastomosis with four different sutures of an absorbable suture (2.0 VICRYL^®). Inclusion criteria were primary laparoscopic gastric bypasses. Exclusion criteria were revisions and conversions to open procedures and combined procedures.

Results:

From 2010 to 2013, there were 454 primary LRYGB. The overall stricture rate was 3.1% with 14 patients. This varied by year from a low of 0% in 2013 to 4.2% in 2012. The average time to stricture was 57.5 days with a standard deviation of 29 days. One patient had a recurrent stricture, and all patients responded to pneumatic dilation.

Conclusions:

A two-layered HS anastomosis has an acceptable rate of stricture. These strictures are early and respond well to pneumatic dilation.