TITLE:
Hand-Sewn Running Barbed Suture versus Endoscopic Stapler Closure of the Mesenteric Defects in Retrocolic and Retrogastric RYGB: A Comparative Case-Matched Study
AUTHORS:
V. Simonelli, G. Orlando, A. Zolotas, C. Arendt, L. Arru, V. Poulain, J. S. Azagra, M. Goergen
KEYWORDS:
Laparoscopy, Gastric Bypass, Fastrack, Internal Hernia
JOURNAL NAME:
Surgical Science,
Vol.6 No.8,
July
29,
2015
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.