Comparison of gastrojejunostomy techniques and anastomotic complications: a systematic literature review
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and Other Interventional Techniques
Comparison of gastrojejunostomy techniques and anastomotic complications: a systematic literature review Steliana Fakas1 · Murad Elias1 · Derek Lim2 · Vadim Meytes3 Received: 22 June 2020 / Accepted: 27 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background There are several ways to perform the gastrojejunostomy (GJ) anastomosis in laparoscopic Roux-en-Y gastric bypass (LRYGB). Surgeons typically use a variation of three techniques: Hand-sewn anastomosis (HSA), Linear stapled (LS) and Circular stapled anastomosis (CSA). The purpose of this literature review is to determine which of the GJ techniques, if any, is superior and results in the least amount of postoperative complications, with a specific focus on rates of marginal ulcers, postoperative bleeding, and strictures. Methods PubMed, Embase, and Cochrane electronic databases were consulted for studies on LRYGB procedures utilizing a GJ anastomosis, from January 1, 2015 to December 31, 2019. Cochrane and PRISMA screening methods were used to select the studies. Results Eleven studies published between 2015 and 2019 were selected and included 135,899 patients that underwent LRYGB with a GJ anastomosis. Sample sizes ranged from 114 to 49,331 patients. Four studies reported that CSA had statistically significant higher rates of marginal ulcers when compared to HSA and LS techniques. Three studies concluded that CSA had statistically significant higher rates of postoperative bleeding when compared to HSA and LS. Five studies observed that CSA had statistically significant higher rates of strictures when compared to HSA and LS techniques. There was no consensus whether HSA or LS was superior in terms of reduced postoperative complications. Conclusion This study revealed statistically significant increases in rates of postoperative bleeding, marginal ulcer, and strictures with the use of mechanical circular staplers at the GJ anastomosis in LRYGB. Based on our results, avoiding the use of mechanical circular staplers can result in fewer postoperative complications. Nevertheless, there are limitations to retrospective studies which may influence the results and therefore a randomized controlled trial directly comparing HSA, CSA, and LS should be performed to truly determine which technique is superior. Keywords Bariatric Surgery · Roux-En-Y Gastric Bypass · Hand-Sewn Anastomosis · Linear stapler anastomosis · Circular stapler anastomosis · Postoperative complications Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a surgical procedure used for weight loss. In this procedure, the stomach is divided into an upper and lower pouch, with the small intestine being rearranged to connect to the upper pouch, a portion of the jejunum. By bypassing the duodenum and not including the fundus and the body of the stomach * Derek Lim [email protected] 1
New York Medical College, Vahalla, NY, USA
2
New York Langone Health-Brooklyn, Brooklyn, NY, USA
3
Nuvance Health Northern Duchess
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