Dual Ring Wound Protector Reduces Circular Stapler Related Surgical Site Infections in Patients Undergoing Laparoscopic Roux-En-Y Gastric Bypass
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While there are various techniques to create the gastrojejunostomy during a laparoscopic Roux-en-Y gastric bypass (LRYGB), many surgeons prefer using a circular stapler. One drawback of this method, however, is the higher incidence of surgical site infections (SSIs). To investigate the effect of a dual ring wound protector on SSIs during LRYGB.
In April 2016, our bariatric surgical group implemented an intervention whereby a dual ring wound protector in conjunction with a conical EEA stapler introducer was used when creating the gastrojejunostomy. SSIs from pre- and post-intervention were compared using Fisher’s exact test. Only LRYGBs performed with a circular stapler were included in our analysis. Student’s t test and χ2 were used to compare pre- and post-intervention groups with respect to demographics and co-morbidities.
Between April 2015 and January 31st, 2017, our surgeons performed 158 LRYGBs using a circular stapler for the gastrojejunostomy. There were 84 patients (53%) in the pre-intervention group and 74 (47%) in the post-intervention group. The pre- and post-intervention groups were not statistically different. The SSI rate for the pre-intervention group was 9.5% while the SSI rate was 1.35% in the post-intervention group (p = 0.0371). The use of a dual ring wound protector for LRYGBs with circular stapled gastrojejunostomy was associated with an 86% relative risk reduction in SSIs.
Using a dual ring wound protector in conjunction with a conical EEA introducer for LRYGBs with circular stapled gastrojejunostomy significantly decreased SSIs.
KeywordsWound protector Dual ring wound protector Anastomosis Bariatric Circular stapler Gastric bypass Laparoscopic gastric bypass Surgical site infection Wound infection
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
- 1.World Health Organization. Global health risks: mortality and burden of disease attributable to selected major risks. October 2009:1–70.Google Scholar
- 2.Yan Y, Sha Y, Yao G, et al. Roux-en-Y gastric bypass versus medical treatment for type 2 diabetes mellitus in obese patients. Medicine. 2016;95(17):e3462–11. https://doi.org/10.1097/MD.0000000000003462.
- 5.Bariatric Surgery Procedures – ASMBS | American Society for Metabolic and Bariatric Surgery. 2017. https://asmbs.org/patients/bariatric-surgery-procedures.
- 7.Korenkov M, Goh P, Yücel N, et al. Laparoscopic gastric bypass for morbid obesity with linear gastroenterostomy. Obes Surg. 2003;13(3):360–3. https://doi.org/10.1381/096089203765887660.
- 8.Bohdjalian A, Langer FB, Kranner A, et al. Circular- vs. linear-stapled Gastrojejunostomy in laparoscopic roux-En-Y gastric bypass. Obes Surg. 2009;20(4):440–6. https://doi.org/10.1007/s11695-009-9998-0.
- 10.Giordano S, Salminen P, Biancari F, et al. Linear stapler technique may be safer than circular in Gastrojejunal anastomosis for laparoscopic roux-en-Y gastric bypass: a meta-analysis of comparative studies. Obes Surg. 2011;21(12):1958–64. https://doi.org/10.1007/s11695-011-0520-0.
- 11.Jiang H-P, Lin L-L, Jiang X, et al. Meta-analysis of hand-sewn versus mechanical gastrojejunal anastomosis during laparoscopic roux-en-Y gastric bypass for morbid obesity. Int J Surg. 2016;32:150–7. https://doi.org/10.1016/j.ijsu.2016.04.024.
- 13.Finks JF, Carlin A, Share D, et al. Effect of surgical techniques on clinical outcomes after laparoscopic gastric bypass—results from the Michigan bariatric surgery collaborative. SOARD. 2011;7(3):284–9. https://doi.org/10.1016/j.soard.2010.10.004.
- 14.Sima E, Hedberg J, Ehrenborg A, et al. Differences in early complications between circular and linear stapled Gastrojejunostomy in laparoscopic gastric bypass. Obes Surg. 2013;24(4):599–603. https://doi.org/10.1007/s11695-013-1139-0.
- 16.Shabino PJ, Khoraki J, Elegbede AF, Schmocker RK, Nabozny MJ, Funk LM, Greenberg JA, Campos GM Reduction of surgical site infections after laparoscopic gastric bypass with circular stapled gastrojejunostomy. January 2016:1–6. doi: https://doi.org/10.1016/j.soard.2015.03.003.
- 18.Alasfar F, Sabnis A, Liu R, et al. Reduction of circular stapler-related wound infection in patients undergoing laparoscopic roux-en-Y gastric bypass Cleveland Clinic Technique. Obes Surg. 2008;20(2):168–72. https://doi.org/10.1007/s11695-008-9708-3.
- 19.Zhang Y, Serrano OK, Melvin WS, et al. An intraoperative technique to reduce superficial surgical site infections in circular stapler–constructed laparoscopic roux-en-Y gastric bypass. Surg Obes Relat Dis. 2016;12(5):1008–13. https://doi.org/10.1016/j.soard.2016.01.003.
- 20.Mihaljevic AL, Schirren R, Özer M, et al. Multicenter double-blinded randomized controlled trial of standard abdominal wound edge protection with surgical dressings versus coverage with a sterile circular polyethylene drape for prevention of surgical site infections. Ann Surg. 2014;260(5):730–9. https://doi.org/10.1097/SLA.0000000000000954.
- 21.Edwards JP, Ho AL, Tee MC, et al. Wound protectors reduce surgical site infection. Ann Surg. 2012;256(1):53–9. https://doi.org/10.1097/SLA.0b013e3182570372.
- 22.Gabrielsen J, Petrick A, Ibele A, et al. A novel technique for wound protector deployment and efficient specimen extraction following laparoscopic sleeve gastrectomy. J Gastrointest Surg. 2014;18(9):1678–82. https://doi.org/10.1007/s11605-014-2512-6.
- 23.Selby LV, Sjoberg DD, Cassella D, et al. Comparing surgical infections in National Surgical Quality Improvement Project and an institutional database. J Surg Res. 2015;196(2):416–20. https://doi.org/10.1016/j.jss.2015.02.072.
- 25.Bressan AK, Roberts DJ, Edwards JP, et al. Efficacy of a dual-ring wound protector for prevention of incisional surgical site infection after Whipple's procedure (pancreaticoduodenectomy) with preoperatively-placed intrabiliary stents: protocol for a randomised controlled trial. BMJ Open. 2014;4(8):e005577–7. https://doi.org/10.1136/bmjopen-2014-005577.
- 27.Reid K, Pockney P, Draganic B, et al. Barrier wound protection decreases surgical site infection in open elective colorectal surgery: a randomized clinical trial. Dis Colon Rectum. 2010;53(10):1374–80. https://doi.org/10.1007/DCR.0b013e3181ed3f7e.
- 28.Cheng KP, Roslani AC, Sehha N, et al. ALEXIS O-ring wound retractor vs conventional wound protection for the prevention of surgical site infections in colorectal resections1. Colorect Dis. 2012;14(6):e346–51. https://doi.org/10.1111/j.1463-1318.2012.02943.x.
- 29.Teixeira JA, Borao FJ, Thomas TA, et al. An alternative technique for creating the gastrojejunostomy in laparoscopic roux-en-Y gastric bypass: experience with 28 consecutive patients. Obes Surg. 2000;10(3):240–4. https://doi.org/10.1381/096089200321643520.