Original article
Effect of surgical techniques on clinical outcomes after laparoscopic gastric bypass—results from the Michigan Bariatric Surgery Collaborative

https://doi.org/10.1016/j.soard.2010.10.004Get rights and content

Abstract

Background

The techniques used with laparoscopic gastric bypass (LGB) and their association with patient outcomes remain largely unexplored.

Methods

We analyzed the data from the Michigan Bariatric Surgery Collaborative, which maintains a state-wide prospective clinical registry of bariatric surgery patients. Participating surgeons were surveyed regarding their use of specific techniques during LGB. The survey data were linked with the registry data from patients undergoing LGB from June 2006 to January 2010. The gastrojejunostomy technique and the use of staple-line reinforcement were evaluated for their effects on patient outcomes.

Results

During the study period, 9904 patients underwent LGB. A total of 44 surgeons (86%) completed the survey. When performing gastrojejunostomy, most surgeons used a circular stapler (CS) technique (66%), followed by the hand-sewn (HS) (18%) and linear stapler (LS) (16%). Also, 48% of surgeons reported using staple-line buttressing when creating the gastric pouch. The rate of anastomotic leak at the gastrojejunostomy was not affected by the surgical technique (CS .6%, LS .3%, HS .6%, P = .38). However, the CS technique was associated with a greater rate of postoperative hemorrhage (CS 2.9%, LS 1.2%, HS 1.6%, P <.0001) and wound infection (CS 4.7%, LS 1.6%, HS .6%, P <.0001). The use of staple-line reinforcement was associated with a lower rate of postoperative hemorrhage (1.9% versus 2.7%, P = .012).

Conclusion

With LGB, the use of the CS technique was associated with greater rates of postoperative hemorrhage and wound infection than the use of the LS or HS technique. Furthermore, the use of staple-line reinforcement was associated with a reduction in the rates of postoperative hemorrhage.

Section snippets

Study population

The present study was based on an analysis of data from the Michigan Bariatric Surgery Collaborative (MBSC), which has been previously described in greater detail [16], [17]. The MBSC is a regional consortium of hospitals and surgeons performing bariatric surgery in Michigan. The collaborative currently collects data for >95% of patients undergoing bariatric surgery in the state, with an annual enrollment of approximately 5000 patients into its clinical registry. Participating centers submit

Patient characteristics

During the study period, 10,236 patients had undergone LGB at 21 centers by 51 surgeons. A total of 9904 patients were included in the present analysis, because the remainder had undergone LGB by a surgeon who did not complete the survey. The baseline patient characteristics stratified by anastomosis type and the use of buttress were similar for all groups (Table 1). The mean age of the entire cohort was 45 years, and the mean body mass index was 48 kg/m2; 80% of the patients were women.

Surgeon characteristics

A total

Discussion

To the best of our knowledge, the present study represents one of the largest series of LGB patients and reflects the results across a broad spectrum of surgical practices. Because of the richness of the clinical registry and the collaborative nature of our consortium, we had a unique opportunity to explore the relationship between the technical variations and patient outcomes for what many consider to be 1 of the most technically challenging operations.

In the present study, we identified a

Conclusion

Our results have demonstrated a greater rate of wound and bleeding complications associated with the CS technique. However, given the benefits of this approach, such as ease of use and consistent size of the anastomosis, improving the technique might prove preferable to abandoning it. Improvement efforts should focus on determining the most appropriate staple height to minimize intraluminal bleeding and identifying strategies to protect the wound from the fired stapler. Finally, consideration

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

References (28)

  • C. Bakhos et al.

    Early postoperative hemorrhage after open and laparoscopic Roux-en-Y gastric bypass

    Obes Surg

    (2009)
  • R. Gonzalez et al.

    Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques

    Arch Surg

    (2003)
  • J.L. Leyba et al.

    Laparoscopic gastric bypass for morbid obesity—a randomized controlled trial comparing two gastrojejunal anastomosis techniques

    JSLS

    (2008)
  • T.R. Shope et al.

    Early results after laparoscopic gastric bypass: EEA vs GIA stapled gastrojejunal anastomosis

    Obes Surg

    (2003)
  • Cited by (0)

    View full text