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Laparoscopic Roux-en-Y Gastric Bypass Without Division of the Mesentery Reduces the Risk of Postoperative Complications
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Hand Surgery. Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0003-1868-292X
2019 (English)In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 33, no 9, p. 2858-2863Article in journal (Refereed) Published
Abstract [en]

Background: Anastomotic complications after laparoscopic Roux-en-Y gastric bypass (LRYGB) including leaks, ulceration, and stenosis remain a significant cause of post-operative morbidity and mortality. Our objective was to compare two different surgical techniques regarding short-term anastomotic complications.

Methods: A retrospective analysis of all patients operated with a primary LRYGB from 2006 to June 2015 in one institution, where prospectively collected data from an internal quality registry and medical journals were analyzed.

Results: In total, 2420 patients were included in the analysis. 1016 were operated with a technique where the mesentery was divided during the creation of the Roux-limb (DM-LRYGB) and 1404 were operated with a method where the mesentery was left intact (IM-LRYGB). Leakage in the first 30 days [2.6% vs. 1.1% (p < 0.05)], and ulceration or stenosis occurring during the first 6 months after surgery [5.6% vs. 0.1% (p < 0.05)] was significantly higher in the DM-LRYGB group. Adjusted odds ratio for anastomotic leak was 0.46 (95% CI 0.24-0.87) and for stenosis/ulceration 0.01 (95% CI 0.002-0.09).

Conclusion: IM-LRYGB seems to reduce the risk of complications at the anastomosis. A plausible explanation for this is that the blood supply to the anastomosis is compromised when the mesentery is divided.

Place, publisher, year, edition, pages
Springer, 2019. Vol. 33, no 9, p. 2858-2863
Keywords [en]
Gastric bypass, LRYGB, Leakage, Stenosis, Ulceration
National Category
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-162658DOI: 10.1007/s00464-018-6581-6ISI: 000479054300015PubMedID: 30460504OAI: oai:DiVA.org:umu-162658DiVA, id: diva2:1348787
Available from: 2019-09-05 Created: 2019-09-05 Last updated: 2019-09-05Bibliographically approved

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