Hand-sewn gastrojejunostomy during laparoscopic Roux-en-Y gastric bypass (RYGB) has fewer complications and lower costs than stapled techniques. However, it is perceived as a more technically demanding and time-consuming technique.
In this study, researchers from the United States performed a retrospective medical record review of prospectively collected data.
The team assessed 108 consecutive patients who underwent laparoscopic RYGB between 1999 and 2001.
The team compared 3 techniques: hand-sewn anastomosis (HSA), circular-stapled anastomosis (CSA), and linear-stapled anastomosis (LSA).
They compared operative costs, including the cost of stapling devices, cost of sutures, and operative times. They also determined rates of anastomotic strictures, leaks, marginal ulcers, bleeding, and wound infections.
The researchers assessed 87 patients underwent who underwent HAS, 13 who underwent CSA, and 8 LSA.
|Supply costs per patient:|
- circular-stapled = $955
- linear-stapled = $435
- hand-sewn = $2
|Archives of Surgery|
They determined that supply costs per patient were higher for CSA ($955) and LSA ($435), than for HSA ($2).
In addition, the mean operative time for laparoscopic RYGB was longer when performing CSA, than for HSA or LSA (285 minutes, 215 minutes, and 204 minutes, respectively).
The team also found that stricture rates were higher after CSA (31%), than HAS (3%) and LSA (0%), respectively.
Furthermore, wound infection rates were higher after CSA (23%), than HAS (1%) and LSA (0%).
There was no difference in anastomotic bleeding, and no anastomotic leaks occurred.
Dr Rodrigo Gonzalez’s team concluded, “In this experience, hand-sewn gastrojejunostomy during laparoscopic RYGB reduced operating room supply costs and was completed faster than stapled techniques”.
“However, these differences may reflect the learning curve because these techniques were used early in our experience.”
“Lower postoperative stricture and wound infection rates seem to be the primary benefits of the HSA technique.”