Completely Mechanical Gastrojejunal Anastomosis: A Novel Way to Perform Laparoscopic Gastric Bypass

Abstract

Background: Laparoscopic Roux-en-Y gastric bypass (L-RYGB), a common procedure for treating obesity, requires a gastrojejunostomy (GJA). The most used techniques for GJA, namely, linear stapling and hand-sewing, have similar outcomes. Since GJA is time-consuming, optimizing GJA would provide a strategic opportunity to reduce surgical times. We describe a completely mechanical GJA (CM-GJA) to standardize its configuration and reduce the creation time of CJA. Additionally, we present our initial experience and learning curve with this technique.

Methods: Retrospective analysis with prospective follow-up of a cohort of 166 patients who underwent L-RYGB or conversion to L-RYGB in Antofagasta, Chile, from January 2020 to January 2023. Patients were divided into four chronological groups based on the date of surgery to evaluate the CM-GJA creation times, and the demographics, surgical aspects, complications, and percentage of excess BMI loss (%EBMIL) at 6 months were analyzed.

Results: Average time for CM-GJA creation was 4 min 34 s. There was a significant reduction in CM-GJA creation time, from 4 min 43 s to 4 min 24 s (p < 0.001). Mean BMI decreased from 41.30 to 30.71 after 6 months; moreover, 82.5% of patients had a %EBMIL ≥ 50%, and 51.8% had a %EBMIL > 65%. Strictures occurred in 1.8% of patients.

Conclusions: CM-GJA implementation in L-RYGB yielded an optimal clinical response, as shown by the procedural learning curve and patient outcomes. These findings suggest that CM-GJA not only reduces GJA creation times but may also enhance safety, supporting its broader adoption in clinical practice.

Keywords: Anastomosis techniques; Bariatric surgery; Gastrojejunostomy (GJA); Laparoscopic Roux-en-Y gastric bypass (L-RYGB); Standardization; Time optimization.