Hand-sewn gastrojejunostomy using knotless unidirectional barbed absorbable suture during laparoscopic gastric bypass

Abstract

Background: This report describes the authors' institutional experience using knotless unidirectional barbed absorbable suture to close the common enterotomy of the jejunojejunostomy (JJ) and to create a hand-sewn gastrojejunostomy (GJ) during laparoscopic Roux-en-Y gastric bypass.

Methods: A retrospective review of morbidly obese patients who underwent laparoscopic gastric bypass with a hand-sewn GJ between April 2011 and 2012 was performed. The authors' traditional technique (TT) consisted of using standard monofilament absorbable suture to close the common JJ enterotomy in a single running layer and to create the GJ with a two-layer anastomosis. A novel technique (NT) was introduced using knotless unidirectional barbed monofilament absorbable suture to perform both tasks. A comparison between these two techniques was performed.

Results: In this study, 84 patients with a mean body mass index of 41.7 ± 4.7 kg/m(2) underwent laparoscopic gastric bypass using a hand-sewn technique. For the 84 patients, 75 primary procedures (89.3 %) and 9 revisional procedures (10.7 %) were performed. In 38 procedures (45.2 %), the TT was used, whereas 46 cases (54.8 %) were managed using the NT. For the primary procedures, the average operating room times were slightly faster in the NT group (178.9 ± 44.4 vs 154.2 ± 74.7 min; p = 0.08). The average hospital length of stay was comparable between the two groups (2.3 ± 0.7 vs 2.6 ± 1.4 days; p = 0.25). A 30-day follow-up assessment was obtained for all 84 patients, without a significant difference in the overall complication rate between the two groups (TT 18.4 % vs NT 13 %; p = 0.77). No complications were secondary to the JJ closure or gastrojejunostomy. The complications included bleeding (n = 1), small bowel obstruction (n = 1), dehydration (n = 2), esophagitis (n = 1), and subarachnoid hemorrhage (n = 1). No anastomotic leak or stenosis occurred in either group. The mean percentage of excess weight loss at 1 month was 21.3 % ± 5.4 %, without a significant difference between the two groups.

Conclusion: In the study cohort, the use of knotless unidirectional barbed suture instead of traditional monofilament absorbable suture had similar 30-day outcomes and appears to be a feasible option for laparoscopic bowel closure and anastomosis creation.