Abstract
Background
Open Roux-en-Y gastric bypass (RYGB) may be chosen because of known widespread adhesions
or as a result of conversion during laparoscopic surgery. Although conversions are
rare, they occur even in experienced hands. The gastrojejunostomy may be performed
with a circular stapler (CS) or a linear stapler (LS) or may be entirely hand sewn
(HS). Our aim was to study differences in outcomes regarding the anastomotic techniques
utilized in open surgery.
Setting
Nationwide cohort.
Methods
Data on open surgery, both primary open and converted procedures from Scandinavian
Obesity Surgery Registry were analyzed for the years 2007–2013. Outcomes were assessed
through multivariate analysis, adjusting for gender, age, preoperative body mass index,
diabetes, conversion, and technique used for the gastrojejunostomy.
Results
CS was the most common method used for primary open RYGB (58%), whereas LS was the
most common for converted RYGB (63%). HS was uncommon in both groups. Operative time
was shorter for LS than for CS in the primary open RYGB (110±40 min versus 132±46
min; P<.001). Anastomotic leakage rates were similar in primary open RYGB (1.0%–2.4%), but
leakage rates for LS in converted procedures was 10.1%, thus higher compared with
2.1% in converted CS patients (P = .02). Odds ratio for leakage was 2.87 (95% confidence interval 1.18–6.97) for LS
using CS as a reference when adjusting for variables above.
Conclusion
LS was associated to increased risk of leakage in patients with conversion from laparoscopic
RYGB to open RYGB. Conversion to open surgery was associated to increased risk of
leakage. Technique used for the gastrojejunostomy did not affect weight loss.
Keywords
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Article info
Publication history
Published online: November 27, 2015
Accepted:
November 24,
2015
Received:
September 16,
2015
Identification
Copyright
© 2015 American Society for Metabolic and Bariatric Surgery. Published by American Society for Metabolic and Bariatric Surgery All rights reserved.
