Decreasing anastomotic and staple line leaks after laparoscopic Roux-en-Y gastric bypass.

BACKGROUND

Anastomotic and staple line leaks (ASL) occur after laparoscopic Roux-en-Y gastric bypass (LRYGB) with a reported incidence as high as 6%. Leaks are the second most common cause of post-LRYGB mortality after pulmonary embolism, and can be associated with significant morbidity. Prevention and early detection may limit both morbidity and mortality.

METHODS

A retrospective analysis of prospectively collected data was performed on all LRYGBs performed in a community hospital by a single surgeon from August 2001 to December 2005. All operations were performed using a linear-stapled anastomosis with buttressing material, handsewn otomy closures, stay sutures, intraoperative leak testing, and fibrin sealant.

RESULTS

760 patients underwent LRYGB during the study period. Eighty-nine percent (n = 674) were female and 11% (n = 86) were male. Mean body mass index (BMI) was 50 kg/m2 (range 36-83 kg/m2). Mean age was 40 years (range 17-72 years). Two patients developed three gastric pouch staple line leaks (0.4%). There were no mortalities.

CONCLUSION

Operative technique, including appropriate staple sizing, staple line reinforcement, handsewn otomy closures, placement of stay sutures, intraoperative leak testing, and placement of fibrin sealant contributed to a lower than expected incidence of ASL after LRYGB in this series.