Gastrojejunostomy During Laparoscopic Gastric Bypass

González, Ricardo Rodríguez; Lee, Edward; Venkatesh, K. R.; Bowers, Steven P.; Smith, C. Daniel

doi:10.1001/archsurg.138.2.181

Cited by 178 publications

(105 citation statements)

References 16 publications

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“…Noshiro et al [11] reported their new technique of making a gastrojejunostomy on the stomach transecting line for a very small remnant stomach, which needed time for suturing the extra incision after gastrojejunostomy. In the present study, we tried to find an easier and faster method for gastrojejunostomy, and we felt that a procedure using a circular-stapling device might be suitable [20,21]. We applied a modified technique using the OrVil TM system and a 25 mm circular stapler.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: a novel surgical procedure for selected early gastric cancer in the upper stomach

et al. 2011

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Total gastrectomy or proximal gastrectomy is usually performed either as an open procedure or laparoscopically for the treatment of early gastric cancer (EGC) in the upper stomach. However, quality of life after either total or proximal gastrectomy is not so satisfactory. The authors report a novel surgical procedure, laparoscopyassisted subtotal gastrectomy (LAsTG), by which a very small remnant stomach is preserved, for the surgery of selected EGCs in the upper stomach. Twenty-three patients with EGC in the upper stomach underwent LAsTG. After lymph node dissection and mobilization of the stomach, the stomach was transected about 2 cm proximal to the tumor and a very small remnant stomach was preserved. An anvil was inserted transorally into the remnant stomach by using the OrVil TM system. The reconstruction method was Rouxen-Y, and hemidouble-stapling gastrojejunostomy with a circular stapler was performed intracorporeally. There were no intraoperative complications or conversions to open surgery. Mean operation time and blood loss were 266.7 min and 54.6 ml, respectively. The overall incidence of early postoperative complications was 17.4%, and two patients underwent reoperation because of duodenal stump leakage and stenosis of the Y-anastomosis, respectively. During the follow-up period, two patients experienced gastrojejunostomy stenosis and both were treated successfully by endoscopic balloon dilation. LAsTG may be performed in selected patients with EGC in the upper stomach. With the described method, a very small remnant stomach can be preserved.

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Section: Discussionmentioning

confidence: 99%

Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: a novel surgical procedure for selected early gastric cancer in the upper stomach

et al. 2011

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“…The third accepted technique is the hand-sewn gastrojejunostomy originally promoted by Higa et al [24]. Although hand-sewn anastomoses may take longer to perform, they result in a lower hospital cost, less anastomotic bleeding, fewer stricture complications, and a lower incidence of wound infection [24][25][26]. In addition, the use of absorbable suture to create the gastrojejunostomy reduces the risk of gastrogastric fistula and marginal ulceration [27].…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass

et al. 2010

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Background Traditional laparoscopic surgery presents some difficulties for morbidly obese patients due to limited motion of instruments related to a thick abdominal wall, intraabdominal fat, and a large hepatic left lobe, with consequent loss of dexterity and greater musculoskeletal discomfort. Robotic technique could potentially overcome these limitations. This study aimed to evaluate robot-assisted laparoscopic Roux-en-Y gastric bypass in morbidly obese patients and to compare the results of robotic assistance with those of traditional laparoscopic technique. Methods Between September 2006 and June 2009, 110 morbidly obese patients underwent laparoscopic Roux-en-Y gastric bypass with robot-assisted hand-sewn gastrojejunal anastomosis using the da Vinci Surgical System. The data for these patients was compared with the data for 423 consecutive patients treated in a standard laparoscopic manner during the same period. Results The patients had a mean preoperative age of 42.6 years, a mean weight of 127.5 kg, and a mean body mass index (BMI) of 46.7 kg/m 2 . The total mean operative time was 247.5 min. The robotic setup time was 10.1 min, and the robotic operative time was 54.5 min. The conversion rate was nil. The intraoperative complication rate was 4.5%. The early and late major postoperative complication rates were 3.6 and 6.4% respectively. The cost per patient was 5777.76 €. For the standard laparoscopy, the operative time was significantly shorter (187 min; p < 0.001), and the costs per patient were significantly lower (4658.28 €; p < 0.001), whereas no differences were found in terms of the intra-or postoperative complication rates, revisional surgery, or hospital length of stay. Conclusions Although safe and intuitive, the robotic approach was burdened by a longer operative time and higher equipment costs. Moreover, it did not seem to provide a real advantage over standard laparoscopy in terms of hospital length of stay and complications rates. Keywords Bariatric surgery Gastrojejunal anastomosis Morbid obesity Robot-assisted gastric bypass Robotic surgery Roux-en-Y gastric bypass To date, bariatric surgery is the only long-term effective therapy available for the morbidly obese population [1][2][3]. Over recent decades, laparoscopic surgical techniques have become the gold standard in bariatric surgery due to advantages such as less postoperative pain, shorter hospital stay, faster postoperative recovery, and minimal scarring [4][5][6]. Moreover, for the obese patient, the mini-invasive approach has demonstrated its ability to reduce postoperative mortality [7,8]. However, the inherent limitations of traditional laparoscopic surgery may cause some technical difficulties due to the limited freedom of motion for the instruments related to the thick abdominal wall and hepatomegaly, with consequent loss of dexterity and greater musculoskeletal discomfort for the surgeon [9].

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“…However, the incidence of marginal ulcer was similar. Similarly, others have found no difference in MU rate with type of anastomosis, including hand sewn vs. circular stapled [20] and linear vs. circular [21,22]. Suggs et al [23] found fewer ulcers with the 21-mm vs 25-mm circular stapler, however.…”

Section: Discussionmentioning

confidence: 94%

Surgical Technique Affects the Incidence of Marginal Ulceration after Roux-en-Y in Gastric Bypass

Lee¹,

McBride²,

Shostrom³

et al. 2013

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Background: Marginal ulceration (MU) is a recognized complication of Roux-en-Y gastric bypass (RYGB) surgery. While several possible risk factors have been reported, the mechanism of MU remains incompletely understood. The aim of this study was to compare the effect of surgical technique on the incidence of MU. Methods and Material: This was a retrospective study of 749 patients undergoing RYGB over a ten-year period with at least one year of follow-up. The diagnosis of MU was made based on clinical symptoms and confirmed by postoperative endoscopy (POE). We assessed four different gastric bypass (GBP) techniques: T1-Open, non-divided stomach, circular stapler, non-vagotomy (n = 332); T2-Open, divided stomach, circular stapler, vagotomy (n = 91); T3-Laparoscopic, divided, circular stapler, vagotomy (n = 152); T4-Laparoscopic, divided, linear stapler, vagotomy (n = 174). Results: The four groups were similar with respect to age and mean BMI. The frequency of POE was 16%, 25%, 28% and 27% in groups T1-T4 respectively (NS). The incidence of MU was significantly lower in T1 (2.1%) compared to T2 (5.5%), T3 (15.1%) and T4 (12.6%), p < 0.05. MU occurred significantly more frequently with an antecolic Roux limb versus retrocolic (14.5% vs 5.6%, p < 0.05). Conclusion: The incidence of MU after RYGB surgery is influenced by surgical technique. The lowest incidence of MU was with a non-divided stomach, no vagotomy, transverse staple line, and circular stapled anastomosis. A retrocolic Roux limb was protective. There was no difference in the incidence of MU using laparoscopic versus open bypass if a similar technique was employed or using linear versus circular stapler for the gastrojejunostomy.

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Gastrojejunostomy During Laparoscopic Gastric Bypass

Cited by 178 publications

References 16 publications

Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: a novel surgical procedure for selected early gastric cancer in the upper stomach

Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: a novel surgical procedure for selected early gastric cancer in the upper stomach

Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass

Surgical Technique Affects the Incidence of Marginal Ulceration after Roux-en-Y in Gastric Bypass

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