Oversewing staple line of the gastric remnant in gastric bypass reduces postoperative bleeding

Borjas, Guillermo; González, Maria Posada; Maldonado, Andres; Urdaneta, Ali; Ramos, Eduardo

doi:10.1016/j.amsu.2021.102534

Cited by 5 publications

(6 citation statements)

References 11 publications

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“…In our study, pelviabdominal CT was not ordered contrary to what was mentioned in other studies 12–15 . In our plan of management, if conservative management succeeded, there was no need for CT scan.…”

Section: Discussioncontrasting

confidence: 60%

“…That is why they recommend oversewing the gastric remnant in all cases. 13 In a multicenteric study 46 out of 2678 patients had early postoperative bleeding (1.7%). Univariate analysis showed intraluminal bleeding more frequent in patients in whom no sealant was used and in whom the surgeon is in early phase of learning curve.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, pelviabdominal CT was not ordered contrary to what was mentioned in other studies. [12][13][14][15] In our plan of management, if conservative management succeeded, there was no need for CT scan. In contrast, if patients did not respond to initial resuscitation, endoscopic or laparoscopic intervention was carried out.…”

Section: Discussionmentioning

confidence: 99%

“…Borjas and colleagues concluded that oversewing the staple line of the gastric remnant reduces bleeding after both OAGB and RYGB. That is why they recommend oversewing the gastric remnant in all cases 13 …”

Section: Discussionmentioning

confidence: 99%

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Management of Early Postoperative Bleeding After OAGB: A Single-center Experience

Helmy,

Elbanna,

El-Zemeity

et al. 2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Introduction: One anastomosis gastric bypass (OAGB) has gained popularity among bariatric surgeons due to the shorter operative time, fewer sites for anastomotic leaks and internal herniation, shorter learning curve, ease of reversibility and revision with equivalent results to Roux en Y gastric bypass in terms of weight loss and co-morbidity resolution. We present our experience in managing early postoperative bleeding after OAGB. Patients and Methods: Patients who underwent OAGB in Bariatric Surgery Unit, Ain Shams University Hospitals between January 2016 and January 2023 were followed up for 30 days for early postoperative complications. Patients were 210 females (70%) and 90 males, with a mean age of 41.3±7.1 years, and mean preoperative body mass index of 45.2±6.1 kg/m². The incidence of early postoperative bleeding, the sites of the bleeding and management strategy were reported. Results: Fourteen of 300 patients (4.67%) developed early postoperative bleeding after OAGB. Intraluminal bleeding occurred in 4 patients, 3 of which were controlled by endoscopy and one by laparoscopic suturing. Intra-abdominal bleeding occurred in 10 patients, 7 of which were successfully managed conservatively, and 3 required laparoscopic management. Two cases had both intra-abdominal bleeding and intraluminal bleeding in the distal stomach, confirmed by intraoperative endoscopy, and controlled by laparoscopic suturing. Conclusion: Early postoperative bleeding after OAGB is a rare complication (4.67%). Conservative treatment is more successful in controlling intra-abdominal bleeding. In case of failed conservative treatment, laparoscopy is the method of choice. Most cases of intra-luminal bleeding need early endoscopic intervention.

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Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of Early Postoperative Bleeding After OAGB: A Single-center Experience

Helmy,

Elbanna,

El-Zemeity

et al. 2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…Bleeding can be of various origins: intra-luminal bleeding (ILB) related to bleeding from the staple-lines or an acute marginal ulcer at the gastrojejunostomy (GJ), whereas extra-luminal bleeding (ELB) refers to bleeding occurring in the abdominal cavity or from the port-sites. Several technical recommendations have been described to minimize POB incidence: the use of 3.5-mm circular stapler height for confection of the GJ [6][7][8], bidirectional Tri-Staple technique for the confection of the jejunojejunostomy (JJ) [9] and oversewing of the staple lines [10].…”

Section: Key Pointsmentioning

confidence: 99%

Early Bleeding After Laparoscopic Roux-en-Y Gastric Bypass: Incidence, Risk Factors, and Management — a 21-Year Experience

et al. 2022

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Purpose Morbidity and mortality associated with bariatric surgery are considered low. The aim of this study is to assess the incidence, clinical presentation, risk factors, and management of early postoperative bleeding (POB) after laparoscopic Roux-en-Y gastric by-pass (RYGB). Materials and Methods Retrospective analysis of prospectively collected data of consecutive patients who underwent RYGB in 2 expert bariatric centers between January 1999 and April 2020, with a common bariatric surgeon. Results A total of 2639 patients underwent RYGB and were included in the study. POB occurred in 72 patients (2.7%). Intraluminal bleeding (ILB) was present in 52 (72%) patients and extra-luminal bleeding (ELB) in 20 (28%) patients. POB took place within the first 3 postoperative days in 79% of patients. The most frequent symptom was tachycardia (63%). Abdominal pain was more regularly seen with ILB, compared to ELB (50% vs. 20%, respectively, p = 0.02). Male sex was an independent risk factor of POB on multivariate analysis (p < 0.01). LOS was significantly longer in patients who developed POB (8.3 vs. 3.8 days, p < 0.01). Management was conservative for most cases (68%). Eighteen patients with ILB (35%) and 5 patients with ELB (25%) required reoperation. One patient died from multiorgan failure after staple-line dehiscence of the excluded stomach (mortality 0.04%). Conclusion The incidence of POB is low, yet it is the most frequent postoperative complication after RYGB. Most POB can be managed conservatively while surgical treatment is required for patients with hemodynamic instability or signs of intestinal obstruction due to an intraluminal clot. Graphical abstract

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Prediction Factors of Early Postoperative Bleeding after Bariatric Surgery

Golzarand

Toolabi

Parsaei³

2022

OBES SURG

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Oversewing staple line of the gastric remnant in gastric bypass reduces postoperative bleeding

Cited by 5 publications

References 11 publications

Management of Early Postoperative Bleeding After OAGB: A Single-center Experience

Management of Early Postoperative Bleeding After OAGB: A Single-center Experience

Early Bleeding After Laparoscopic Roux-en-Y Gastric Bypass: Incidence, Risk Factors, and Management — a 21-Year Experience

Prediction Factors of Early Postoperative Bleeding after Bariatric Surgery

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