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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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.
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.
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.
KeywordsGastric bypass Roux-en-Y Kinking Bowel obstruction Intestinal obstruction Mesenteric defect Jejunojejunal anastomosis Jejunojejunostomy Postoperative complications
Compliance with Ethical Standards
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.
Informed consent was obtained from all individual participants included in the study.
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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