Anastomosis size contributes to bleeding and stenosis rates

Anastomosis size

The researchers collected data on the incidence of various complications: presence of gastrojejunostomy anastomosis stenosis, occurrence of fistulas, bleeding with transfusion indication and surgical site infection

A study comparing the incidence of early complications related with the handsewn gastrojejunal anastomosis in gastric bypass using Fouchet catheter with different diameters, has reported that a diameter of the anastomosis of 15 mm was related with lower incidence of stenosis. However, the study also found that these patients had major bleeding postoperatively and lower surgical site infection, with no incidences of anastomotic leaks.

The study, ‘Complications related to gastric bypass performed with different gastrojejunal diameters’, from authors from the Bariatric Surgery and Metabolic Service of Holy House Hospital of Curitiba, Curitiba PR, Brazil, published in the journal Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), included 732 patients who underwent RYGB between January 2012 to March 2013. The patients were divided in two groups; group 1 with 12 mm anastomosis (n=374, Fouchet probe of 36 Fr); and group 2 with 15 mm (n=358, Fouchet probe of 44 Fr).

The researchers collected data on the incidence of various complications: presence of gastrojejunostomy anastomosis stenosis, occurrence of fistulas, bleeding with transfusion indication and surgical site infection.

In the procedures, food handle with 140cm was placed in a pre-colic and pre-gastric position. Next, gastrojejunal anastomosis manual laterolateral was performed in anterior gastric wall in two layers with 3-0 absorbable monofilament long half-life in all patients (Figure 1).

Figure 1: Final aspect of gastrojejunal laterolateral anastomosis with the gastric wall after the passage of the Fouchet probe for calibration

Outcomes

The outcomes showed that both groups showed similar results with respect to age, gender, body mass index, presence of comorbidities such as hypertension, dyslipidemia, diabetes mellitus, sleep apnoea and time of postoperative gastric bypass.

Groups 1 (12 mm) with 374 patients and 2 (15mm) with 358 showed gastrojejunostomy stenosis rates of 11% and 3.1%, respectively, requiring dilatation. Statistical significance was verified with p=0.05 (Table 1). Other variables related to the anastomosis were also analysed, but without statistical significance (p>0.05).

Table 1: Incidence of complications related to gastrojejunostomy and gastric bypass

In group 1 (12 mm gastrojejunostomy anastomosis), ten patients reported bleeding (2.8%), compared to group 2 (15 mm anastomosis) 17 patients (4.7%). In both groups studied, the occurrence of surgical site infection occurred in eight patients (2.1%) in group 1, and in seven patients (1.7%) in group 2.