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Bidirectional Jejunojejunal Anastomosis Prevents Early Small Bowel Obstruction Due to the Kinking After Closure of the Mesenteric Defect in the Laparoscopic Roux-en-Y Gastric Bypass

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Abstract

Background

The closure of the mesenteric defects (CMD) in Roux-en-Y gastric bypass (RYGB) reduces the risk of small bowel obstruction (SBO) due to internal hernia but might be associated with an increased risk of early SBO triggered by the jejunojejunal anastomosis (JJS) kinking. The aim of this study was to assess how enlarging the JJS with a bidirectional linear stapling can aid in avoiding the risk of early SBO by kinking.

Materials and Methods

This retrospective cohort study concerns 1327 patients who underwent RYGB with CMD between May 2007 and August 2016. The first 626 patients (group A) had a unidirectional JJS. The following 701 patients (group B) had a bidirectional side-to-side JJS and a hand-sewn closure of the remaining defect. We compared early SBO between the two groups.

Results

Eleven (1.75%) early SBO due to the JJS kinking occurred in group A, whereas none occurred in group B (p = 0.0012). Thirty-nine early postoperative complications happened in group A versus 32 in group B (p = 0.17). Nine (1.2%) digestive bleedings occurred in group B versus two (0.3%) in group A (OR = 4.05 [0.87–18], p = 0.054). Average operating time was 81 min [37–330] in group A and 77 min [33–240] in group B.

Conclusion

Enlarging the JJS with a bidirectional linear stapling is associated with a reduced risk of early SBO due to the anastomosis kinking. However, it could be related to an increased risk of digestive bleedings.

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Authors and Affiliations

  1. Hôpital Pasteur, 39 Avenue de la Liberté, 68024, Colmar, France

    Pierre Munier, Hefzi Alratrout, Iole Siciliano & Philippe Keller

  2. Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67000, Strasbourg, France

    Pierre Munier & Hefzi Alratrout

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  1. Pierre Munier
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Correspondence to Pierre Munier.

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Conflict of Interest

Doctor Pierre Munier declares no conflict of interest.

Doctor Hefzi ALRATROUT declares no conflict of interest.

Doctor Iole Siciliano declares no conflict of interest.

Doctor Philippe Keller declares receiving fees from Ethicon SAS (Johnson&Johnson Medical Devices Companies) for ensuring training sessions.

The authors are not compensated and retained the control over the content of the manuscript.

Consent Statement

Informed consent was obtained from all individual participants included in the study.

Ethical Statement

The study was performed in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

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Munier, P., Alratrout, H., Siciliano, I. et al. Bidirectional Jejunojejunal Anastomosis Prevents Early Small Bowel Obstruction Due to the Kinking After Closure of the Mesenteric Defect in the Laparoscopic Roux-en-Y Gastric Bypass. OBES SURG 28, 1838–1844 (2018). https://doi.org/10.1007/s11695-017-3094-7

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