Risk of Gastrojejunal Anastomotic Stricture with Multifilament and Monofilament Sutures after Hand-Sewn Laparoscopic Gastric Bypass: A Prospective Cohort Study

Abstract

Anastomotic GJ stricture is a common and well-known complication of laparoscopic gastric bypass for morbid obesity. Hand sewing with monofilament suture significantly lowered the frequency of this complication, and hence, monofilament should be the suture material of choice for this suturing technique.

A comparative study of handsewn versus stapled gastrojejunal anastomosis in laparoscopic Roux-en-Y gastric bypass

“…The rate of stricture formation quoted in the literature ranges from 0 to 33.3% [6][7][8][9][10]. Furthermore, these rates have encompassed circular stapled, linear stapled, and handsewn GJ anastomotic techniques, and all of these techniques have reported both high and low rates of stricture formation [11], which makes the literature confusing. Carrodeguas and colleagues reviewed 1,291 patients at their institution and published a stricture rate of 7.3% [15].…”

“…Higa et al [22] reported a stricture rate of 4.9% with handsewn anastomosis in a series of 1,040 cases; this corresponds with our stricture rate. Adana et al [11] reported a randomized study comparing stricture rates using monofilament and braided suture in a handsewn GJ, and the stricture rates were 0.7 and 9.7%. This stricture rate needs to be reproduced by other groups to validate this hypothesis.…”

“…The optimal technique for the creation of the GJ anastomosis is still debatable. Multiple studies have examined the rate of anastomotic stricture and leak using various GJ anastomotic techniques; however, a limited number of studies compare any two techniques [7,11]. One of these looked at comparing a circular stapled technique with a linear stapled technique [7].…”

“…One of these looked at comparing a circular stapled technique with a linear stapled technique [7]. Another study compared the incidence of stricture using different suture material for handsewn anastomosis [11]. One more retrospective case study, which compared 108 consecutive patients who underwent LRYGBP (87 with handsewn, 13 with circular stapled, and 8 with linear stapled anastomoses), found a lower rate of stricture in the handsewn group and no anastomotic leaks [12].…”

Stenosis in gastric bypass for morbid obesity

“…Vasquez et al (11) report fewer complications at the gastro-jejunal anastomosis in their series of 315 gastric bypasses when the reinforcing suture applied on the 25-mm circular stapling is made out of resorbable thread. Ruiz de Adana et al (12), in their prospective cohort study on 242 LGB procedures with manual anastomosis, obtained 9.5% of stenosis in the gastro-jejunal anastomoses with resorbable multifilament suture, and 0.7% in the group receiving resorbable monofilament thread.…”