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 SS  Vol.6 No.8 , August 2015
Hand-Sewn Running Barbed Suture versus Endoscopic Stapler Closure of the Mesenteric Defects in Retrocolic and Retrogastric RYGB: A Comparative Case-Matched Study
Abstract: Background: Obesity is nowadays a major health concern in Western countries and the number of bariatric surgical procedures being performed worldwide is vertiginously rising. The Laparoscopic Roux-en-Y gastric bypass (LRYGB) has become the gold standard bariatric procedure. The retrocolic retrogastric approach is closer to normal anatomy and it is associated to a lower rate of anastomotic leak, a lower rate of gastrojejunal stricture and a lower rate of marginal ulcers; therefore the problem of small bowel obstruction due to internal hernia (IH) has to be faced. The meticulous closure of all possible mesenteric defects with running, non-absorbable sutures may reduce the rate of this complication, but it can be challenging for the surgeon and it rises the operating time (OT). This study has conducted in a context of optimization of our “Fast Track-type” recovery protocol and it aims to compare the rate of early IH and the OT difference when mesenteric defects are closed using running non-absorbable barbed suture or an endoscopic stapler. Materials and Methods: From December 2014 to February 2015 a single-surgeon consecutive series of 22 patients undergoing retrocolic restrogastric LRYBP in our high volume obesity centre has been retrospectively extrapolated from our prospective longitudinal database. We recorded the overall OT and relative rate of IH in patients who received a 15-cm non-absorbable V-LocTM1 (group A, 11 patients) or EndopathTM EMS, endoscopic multifeed stapler2 (group B, 11 patients) defect. Results: The mean OT was 77.36 minutes in the group A and 60.90 minutes in the group B (P value 0.066). 0 patients (0%) in the group A versus 4 patients (36.3%) in the group B developed IH within 30 days (two-tailed P value at chi-square test: 0.02). Conclusion: Early rate of small bowel obstruction due to IH is extremely higher with the use of an endoscopic stapler instead of non-absorbable barber suture and there is not significant difference in the OT; more prospective randomized trials observing bigger series of patients with longer follow-up are needed to validate our study.
Cite this paper: Simonelli, V. , Orlando, G. , Zolotas, A. , Arendt, C. , Arru, L. , Poulain, V. , Azagra, J. and Goergen, M. (2015) Hand-Sewn Running Barbed Suture versus Endoscopic Stapler Closure of the Mesenteric Defects in Retrocolic and Retrogastric RYGB: A Comparative Case-Matched Study. Surgical Science, 6, 346-351. doi: 10.4236/ss.2015.68051.
References

[1]   Nguyen, N.T., DeMaria, E., Ikramuddin, S., et al. (2008) The SAGES Manual: A Practical Guide to Bariatric Surgery. Springer, New York.
http://dx.doi.org/10.1007/978-0-387-69171-8

[2]   Angrisani, L., Santonicola, A., Formisano, G., Buchwald, H. and Scopinaro, N. (2015) Bariatric Surgery Worldwide 2013. Obesity Surgery.

[3]   Muller, M.K., Guber, J., Wildi, S., Guber, I., Clavien, P.A. and Weber, M. (2007) Three-Year Follow-Up Study of Retrocolic versus Antecolic Laparoscopic Roux-en-Y Gastric Bypass. Obesity Surgery, 17, 889-893.
http://dx.doi.org/10.1007/s11695-007-9165-4

[4]   Edwards, M.A., Jones, D.B., Ellsmere, J., Grinbaum, R. and Schneider, B.E. (2007) Anastomotic Leak Following Antecolic versus Retrocolic Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity. Obesity Surgery, 17, 292-297.
http://dx.doi.org/10.1007/s11695-007-9048-8

[5]   Ribeiro-Parenti, L., Arapis, K., Chosidow, D., Dumont, J.L., Demetriou, M. and Marmuse, J.P. (2015) Gastrojejunostomy Stricture Rate: Comparison between Antecolic and Retrocolic Laparoscopic Roux-en-Y Gastric Bypass. Surgery for Obesity and Related Diseases.

[6]   Ribeiro-Parenti, L., Arapis, K., Chosidow, D. and Marmuse, J.P. (2015) Comparison of Marginal Ulcer Rates between Antecolic and Retrocolic Laparoscopic Roux-en-Y Gastric Bypass. Obesity Surgery, 25, 215-221.
http://dx.doi.org/10.1007/s11695-014-1392-x

[7]   Escalona, A., Devaud, N., Perez, G., Crovari, F., Boza, C., Viviani, P., Ibanez, L. and Guzman, S. (2007) Antecolic versus Retrocolic Alimentary Limb in Laparoscopic Roux-en-Y Gastric Bypass: A Comparative Study. Surgery for Obesity and Related Diseases, 3, 423-427.
http://dx.doi.org/10.1016/j.soard.2007.04.005

[8]   Higa, H.D., Ho, T. and Boone, K.B. (2003) Internal Hernias after Laparoscopic Roux-en-Y Gastric Bypass: Incidence, Treatment and Prevention. Obesity Surgery, 13, 350-354.
http://dx.doi.org/10.1381/096089203765887642

[9]   Buchwald, H. and Oien, D.M. (2009) Metabolic/Bariatric Surgery Worldwide 2008. Obesity Surgery, 19, 1605-1611.
http://dx.doi.org/10.1007/s11695-009-0014-5

[10]   McCarty, T.M., Arnold, D.T., Lamont, J.P., Fisher, T.L. and Kuhn, J.A. (2005) Optimizing Outcomes in Bariatric Surgery: Outpatient Laparoscopic Gastric Bypass. Annals of Surgery, 242, 494-498.
http://dx.doi.org/10.1097/01.sla.0000183354.66073.4c

[11]   Fares, L.G., Reeder, R.C., Bock, J. and Batezel, V. (2008) 23-Hour Stay Outcomes for Laparoscopic Roux-en-Y Gastric Bypass in a Small, Teaching Community Hospital. American Surgeon, 74, 1206-1210.

[12]   Thomas, H. and Agrawal, S. (2011) Systematic Review of 23-Hour (Outpatient) Stay Laparoscopic Gastric Bypass Surgery. Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A, 21, 677-681.
http://dx.doi.org/10.1089/lap.2011.0042

[13]   Steele, K.E., Prokopowicz, G.P., Magnuson, T., et al. (2008) Laparoscopic Antecolic Roux-en-Y Gastric Bypass with Closure of Internal Defects Leads to Fewer Internal Hernias than the Retrocolic Approach. Surgical Endoscopy, 22, 2056-2061.
http://dx.doi.org/10.1007/s00464-008-9749-7

[14]   Carmody, B., De Maria, E.J., Jamal, M., et al. (2005) Internal Hernia after Laparoscopic Roux-en-Y Gastric Bypass. Surgery for Obesity and Related Diseases, 1, 543-548.
http://dx.doi.org/10.1016/j.soard.2005.08.005

[15]   Facy, O., De Blasi, V., Goergen, M., Arru, L., De Magistris, L. and Azagra, J.S. (2013) Laparoscopic Gastrointestinal Anastomoses Using Knotless Barbed Sutures Are Safe and Reproducible: A Single-Center Experience with 201 Patients. Surgical Endoscopy, 27, 3841-3845.
http://dx.doi.org/10.1007/s00464-013-2992-6

[16]   Murtha, A.P., Kaplan, A.L., Paglia, M.J., et al. (2006) Evaluation of a Novel Technique for Wound Closure Using a Barbed Suture. Plastic and Reconstructive Surgery, 117, 1769-1780.
http://dx.doi.org/10.1097/01.prs.0000209971.08264.b0

[17]   Costantino, F., Dente, M., Perrin, P., et al. (2013) Barbed Unidirectional V-Loc 180 Suture in Laparoscopic Roux-en-Y Gastric Bypass: A Study Comparing Unidirectional Barbed Monofilament and Multifilament Absorbable Suture. Surgical Endoscopy, 27, 3846-3851.
http://dx.doi.org/10.1007/s00464-013-2993-5

[18]   Tyner, R.P., Clifton, G.T. and Fenton, S.J. (2013) Hande-Sewn Gastrojejunostomy Using Knotless Unidirectional Barbed Absorbable Suture during Laparoscopi Gastric Bypass. Surgical Endoscopy, 27, 1360-1366.
http://dx.doi.org/10.1007/s00464-012-2616-6

 
 
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