A Prospective Evaluation of Intracorporeal Laparoscopic Small Bowel Anastomosis during Gastric Bypass |
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| Authors: | Ninh T Nguyen MD Ann M Neuhaus MD Gabriela G Furdui MD Bruce M Wolfe MD Hung S Ho MD Levi S Palmer BS |
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| Affiliation: | (1) Minimally Invasive Surgery Program, Department Medical Center, Sacramento, California, USA of Surgery, University of California, Davis, Medical Center, Sacramento, USA;(2) Minimally Invasive Surgery Program, Department Medical Center, Sacramento, California, USA of Surgery, University of California, Davis, Medical Center, Sacramento, USA;(3) Minimally Invasive Surgery Program, Department Medical Center, Sacramento, California, USA of Surgery, University of California, Davis, Medical Center, Sacramento, USA;(4) Minimally Invasive Surgery Program, Department Medical Center, Sacramento, California, USA of Surgery, University of California, Davis, Medical Center, Sacramento, USA;(5) Minimally Invasive Surgery Program, Department Medical Center, Sacramento, California, USA of Surgery, University of California, Davis, Medical Center, Sacramento, USA;(6) Minimally Invasive Surgery Program, Department Medical Center, Sacramento, California, USA of Surgery, University of California, Davis, Medical Center, Sacramento, USA |
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| Abstract: | Background: We evaluated the safety and feasibility of performing a laparoscopic intracorporeal end-toside small bowel anastomosis using a stapling technique as part of a Roux-en-Y gastric bypass operation (RYGBP). Methods: 80 consecutive patients who underwent RYGBP with laparoscopic jejunojejunostomy were evaluated. Operative time and intraoperative and postoperative complications directly related to the jejunojejunostomy anastomosis were recorded. Results: All 80 laparoscopic jejunojejunostomy procedures were successfully performed without conversion to laparotomy. Mean operative time was longer for the first 40 laparoscopic RYGBP than for the last 40 RYGBP (32±18 min vs 21±14 min, respectively, p<0.05). Intraoperative complications were staple-line bleeding (2 patients) and narrowing of the anastomosis (1 patient). Postoperative complications were four small bowel obstructions: technical narrowing at jejunojejunostomy site (2 patients), angulation of the afferent limb (1 patient), and food impaction at the jejunojejunostomy anastomosis (1 patient). These four patients underwent successful laparoscopic re-exploration and creation of another jejunojejunostomy proximal to the original anastomosis. There were no small bowel anastomotic leaks. The median time to resuming oral diet was 2 days. Conclusions: Laparoscopic jejunojejunostomy as part of the RYGBP operation is a safe and technically feasible procedure. Postoperative small bowel obstruction is a potential complication, which can be prevented by avoiding technical narrowing of the afferent limb. |
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| Keywords: | LAPAROSCOPY MORBID OBESITY GASTRIC BYPASS BARIATRIC SURGERY |
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