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Roux-en-Y Gastric Bypass: Does the Direction of Staples Matter?

Sahloul, Mohamed and Karim, Ahmed and Chohan, Kuljit S and Tahrani, Abd A and Mahawar, Kamal and Richardson, Martin and Ludwig, Christian and Daskalakis, Markos and Singhal, Rishi (2018) Roux-en-Y Gastric Bypass: Does the Direction of Staples Matter? Obesity surgery. ISSN 1708-0428. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs

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Official URL: https://link.springer.com/article/10.1007%2Fs11695...

Abstract

PURPOSE

Mechanical gastro-intestinal anastomosis using stapler is a critical step in laparoscopic Roux-en-Y gastric bypass (RYGB). To date the effect of the direction of staples on anastomotic leak has not been investigated. The study aim was to investigate the impact of the direction of staples on the integrity of the gastro-jejunal anastomosis.

MATERIALS AND METHODS

Eight gastro-jejunostomy (GJ) models were performed using porcine stomach and small intestine. Specimens were divided into group A where the cartridge was in the gastric lumen with the anvil in the jejunal lumen and vice versa in group B. Enterotomy was closed and gastric and jejunal ends were stapled off. Burst pressure (BP) was measured by infusion of methylene blue saline into the GJ model until leak occurred. Site of leak, BP, and total volume (TV) infused were recorded. Compliance (C) was calculated from the equation ΔTV/ΔBP.

RESULTS

The BP was greater in group A compared to group B (18 mmHg (range 15-25) versus 11 mmHg (range 8-15); p = 0.045) despite similar TV between the groups 60.00 mL (range 55.00-65.00) versus 51.25 mL (range 40.00-60.00); p = 0.11). The compliance did not significantly differ between groups A and B (6.38 mL/mmHg (range 4.34-8.59) versus 5.61 mL/mmHg (range 3.93-7.21); p = 0.48).

CONCLUSION

BP recorded when the stapler cartridge was introduced in the gastric lumen was higher than when it was introduced from the jejunal lumen. The lack of difference in compliance between groups suggests that the difference in BP was due to the difference in the direction of staples.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Subjects: WK Endocrine system. Endocrinology
WO Surgery
Divisions: Planned IP Care > General Surgery
Related URLs:
Depositing User: Mrs Caroline Tranter
Date Deposited: 04 May 2018 13:44
Last Modified: 04 May 2018 13:44
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1643

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