A biodegradeable membrane from porcine intestinal submucosa to reinforce the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass: preliminary report

Backround: A Silastic ring has been used to prevent dilation of the gastrojejunostomy in Roux-en-Y gastricbypass (RYGBP). The use of a bio-membrane may prevent dilation of the anastomosis without the risks associated with prostheses. The aim of this studywas to evaluate the feasibility and safety of applying such a bio-mem brane around the gastrojejunostomy junostomy in Laparoscopic RYGBP (LRYGBP). Methods: We used a new bio-membrane, that is dreived from porcine small intestinal submucosa (SIS)and acts as a scaffolding for the ingrowth of connective tissue. Over a 4-month period, 14 LRYGBP patients had their proximal anastom osis wrapped with 10 x 2.5 cm SIS by a single surgeon. We compared these patients to a control group of LRYGBP patients matched for BMI. Results: The average age of the patients was 35.0 years (control group: 45.1 years). The patients had a mean initial BMI of 44.7 kg/m² (±5.9) standard error, and the control subjects had a mean initial BMI of 46.7 kg/m² (±6.5). SIS application took a mean time of 11 (±3) minutes without any intraoperative complication. The median hospital stay was 3.5 days in the experimental group and 3.7 days in controls. Three patients developed a symptomatic stenosis at the gastrojejunostomy following surgery. In the control group there were two stenoses. At an average follow-up of 87 days (controls: 95 days), the mean reduction in BMI was 7.8 (± 0.8) kg/m² controls 8.6 kg/m² (± 1.5)]. Conclusion: Application of SIS around the gastrojejunostomy in patients undergoing LRYGBP is feasible and safe. Further follow-up is required, however, to evaluate the effectiveness in preventing dilation of the anastomosis.