Laparoscopic hand-sewn gastrojejunal anastomoses

Abstract

Background: Reconstruction of the digestive tract during gastric bypass (RYGBP) or biliopancreatic diversion (BPD) involves a mechanical or a hand-sewn gastrojejunal anastomosis. The object of this paper is to assess laparoscopic hand-sewn gastrojejunal anastomoses.

Methods: A series of morbidly obese patients was treated with RYGBP or BPD with a laparoscopic hand-sewn gastrojejunal anastomosis at the Hospital Universitario de Getafe-Madrid (Spain) between March 2001 and November 2007.

Results: The series comprised 250 patients, with 232 RYGBPs and 18 BPDs performed. The mean BMI was 46 +/- 4. Only a single case of gastrointestinal hemorrhage (0.4%) was recorded, caused by a marginal ulcer in the early postoperative period (day 6). In the late postoperative period, there were two cases of ulcer (0.8%), one complicated by hemorrhage, the other by perforation. There was no anastomotic leak. One patient (0.4%) required reintervention after 48 h because of thermal perforation of the gastric pouch. There were 11 cases of stenosis (4.4%) requiring radiologically or endoscopically guided dilatation, none in the BPD patients. Mean anastomosis time was 40 +/- 15 min. No cases of mortality or abscess, abdominal sepsis, or thromboembolism were recorded. Mean hospital stay was 5.1 +/- 2.4 days.

Conclusions: Laparoscopic hand-sewn anastomoses are safe and reproducible by surgeons experienced in internal suturing and knot-tying. The technique lengthens operating time, but constant training develops the surgeon's skills, significantly shortening operating time.