Advertisement

Obesity Surgery

, Volume 28, Issue 7, pp 1838–1844 | Cite as

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

  • Pierre Munier
  • Hefzi Alratrout
  • Iole Siciliano
  • Philippe Keller
Original Contributions

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.

Keywords

Gastric bypass Roux-en-Y Kinking Bowel obstruction Intestinal obstruction Mesenteric defect Jejunojejunal anastomosis Jejunojejunostomy Postoperative complications 

Notes

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.

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.

References

  1. 1.
    Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA. 2003;289(2):187–93.  https://doi.org/10.1001/jama.289.2.187.CrossRefPubMedGoogle Scholar
  2. 2.
    Mehta T, Fontaine KR, Keith SW, et al. Obesity and mortality: are the risks declining? Evidence from multiple prospective studies in the United States. Obes Rev. 2014;15(8):619–29.  https://doi.org/10.1111/obr.12191.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Kothari SN, Borgert AJ, Kallies KJ, Baker MT, Grover BT. Long-term (>10-year) outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2016Google Scholar
  4. 4.
    Geubbels N, Lijftogt N, Fiocco M, et al. Meta-analysis of internal herniation after gastric bypass surgery. Br J Surg. 2015;102(5):451–60.  https://doi.org/10.1002/bjs.9738.CrossRefPubMedGoogle Scholar
  5. 5.
    Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003;13(3):350–54.  https://doi.org/10.1381/096089203765887642.CrossRefPubMedGoogle Scholar
  6. 6.
    Stenberg E, Szabo E, Agren G, et al. Early complications after laparoscopic gastric bypass surgery: results from the Scandinavian Obesity Surgery Registry. Ann Surg. 2014;260(6):1040–47.  https://doi.org/10.1097/SLA.0000000000000431.CrossRefPubMedGoogle Scholar
  7. 7.
    Ekelund M. Systematic review and meta-analysis of internal herniation after gastric bypass surgery. Br J Surg. 2015;102(5):451–60.CrossRefGoogle Scholar
  8. 8.
    Stenberg E, Szabo E, Ågren G, et al. Closure of mesenteric defects in laparoscopic gastric bypass: a multicentre, randomised, parallel, open-label trial. Lancet. 2016;387(10026):1397–404.  https://doi.org/10.1016/S0140-6736(15)01126-5.CrossRefPubMedGoogle Scholar
  9. 9.
    Aghajani E, Nergaard BJ, Leifson BG, et al. The mesenteric defects in laparoscopic Roux-en-Y gastric bypass: 5 years follow-up of non-closure versus closure using the stapler technique. Surg Endosc. 2017;31(9):3743–48.  https://doi.org/10.1007/s00464-017-5415-2.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.  https://doi.org/10.1097/SLA.0b013e3181b13ca2.CrossRefPubMedGoogle Scholar
  11. 11.
    Lönroth H. Laparoscopic gastric bypass. Obes Surg. 1998;8(6):563–65.  https://doi.org/10.1381/096089298765553918.CrossRefPubMedGoogle Scholar
  12. 12.
    Costantino F, Dente M, Perrin P, et al. Barbed unidirectional V-Loc 180 suture in laparoscopic Roux-en-Y gastric bypass: a study comparing unidirectional barbed monofilament and multifilament absorbable suture. Surg Endosc. 2013;27(10):3846–51.  https://doi.org/10.1007/s00464-013-2993-5.CrossRefPubMedGoogle Scholar
  13. 13.
    Shimizu H, Maia M, Kroh M, et al. Surgical management of early small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2013;9(5):718–24.  https://doi.org/10.1016/j.soard.2012.05.009.CrossRefPubMedGoogle Scholar
  14. 14.
    Olbers T, Lönroth H, Fagevik-Olsén M, et al. Laparoscopic gastric bypass: development of technique, respiratory function, and long-term outcome. Obes Surg. 2003;13(3):364–70.  https://doi.org/10.1381/096089203765887679.CrossRefPubMedGoogle Scholar
  15. 15.
    Steele KE, Prokopowicz GP, Magnuson T, et al. Laparoscopic antecolic Roux-en-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocolic approach. Surg Endosc. 2008;22(9):2056–61.  https://doi.org/10.1007/s00464-008-9749-7.CrossRefPubMedGoogle Scholar
  16. 16.
    Al Harakeh AB, Kallies KJ, Borgert AJ, et al. Bowel obstruction rates in antecolic/antegastric versus retrocolic/retrogastric Roux limb gastric bypass: a meta-analysis. Surg Obes Relat Dis. 2016;12(1):194–8.  https://doi.org/10.1016/j.soard.2015.02.004.CrossRefPubMedGoogle Scholar
  17. 17.
    Shen SC, Tsai CY, Liao CH, Liu YY, Yeh TS, Liu KH. Learning curve of laparoscopic Roux-en-Y gastric bypass in an Asian low-volume bariatric unit. Asian J Surg. 2017Google Scholar
  18. 18.
    El-Kadre L, Tinoco AC, Tinoco RC, et al. Overcoming the learning curve of laparoscopic Roux-en-Y gastric bypass: a 12-year experience. Surg Obes Relat Dis. 2013;9(6):867.  https://doi.org/10.1016/j.soard.2013.01.020.CrossRefPubMedGoogle Scholar
  19. 19.
    Kristensen SD, Floyd AK, Naver L, et al. Does the closure of mesenteric defects during laparoscopic gastric bypass surgery cause complications? Surg Obes Relat Dis. 2015;11(2):459–64.  https://doi.org/10.1016/j.soard.2014.10.013.CrossRefPubMedGoogle Scholar
  20. 20.
    Brolin RE. The antiobstruction stitch in stapled Roux-en-Y enteroenterostomy. Am J Surg. 1995;169(3):355–57.  https://doi.org/10.1016/S0002-9610(99)80175-5.CrossRefPubMedGoogle Scholar
  21. 21.
    Marr B, Yenumula P. Roux limb volvulus in laparoscopic Roux-en-Y gastric bypass due to Roux limb stabilization suture: case series. Obes Surg. 2012;22(1):4–7.  https://doi.org/10.1007/s11695-011-0529-4.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Hôpital PasteurColmarFrance
  2. 2.Hôpitaux Universitaires de StrasbourgStrasbourgFrance

Personalised recommendations