Initial results with a stapled gastrojejunostomy for the laparoscopic isolated Roux-en-Y gastric bypass

BACKGROUND: The gastric pouch to jejunum anastomosis is a critical step in the performance of an isolated Roux-en-Y gastric bypass. When performing th is procedure laparoscopically, intracorporeal suturing of the gastric pouch to Roux-en-Y jejunum anastomosis is technically demanding, time consuming, and perhaps the most prohibitive part of the operation, We devised a uniqu e, effective, and simple method to perform this anastomosis using an EEA st apler. This report describes this technique and its follow-up in our series of patients undergoing a laparoscopic isolated Roux-en-Y gastric bypass ut ilizing this technique, METHODs: A prospective analysis was performed identifying the technical suc cess, leak rate, and postoperative incidence of anastomotic stenosis and it s management in a consecutive series of patients undergoing a laparoscopic isolated Roux-en-Y gastric bypass with a gastrojejunal anastomosis construc ted with a 21-mm or 25-mm EEA stapler. RESULTS: Forty-eight patients underwent laparoscopic isolated Roux-en-Y gas tric bypass, Mean age was 40.9 years (range 22 to 64) and mean body mass in dex was 52.3 kg/m(2) (range 31 to 76 kg/m(2)). There were no mortalities. T hree patients (6.3%) were converted to an open procedure, but only 1 becaus e of an inability to perform the gastrojejunal anastomosis (short jejunal m esentery). There was 1 leak (2.1%) from the gastrojejunal anastomosis, It w as successfully managed nonoperatively. Thirteen patients (27.1%) patients developed an anastomotic stenosis requiring endoscopic balloon dilatation, Seven of the 13 patients required only a single dilatation and have had no recurrence of dysphagia. Six of the 13 patients needed 2 to 4 dilatations, and all are swallowing normally. None have required surgical revision, Afte r 12 months of follow-up, the mean weight loss was 115 pounds and mean decr ease in body mass index was 18.5 kg/m(2), CONCLUSIONS: The stapled EEA gastrojejunal anastomosis for the laparoscopic isolated Roux-en-Y gastric bypass is safe and effective. Anastomotic steno sis occurs in approximately one quarter of patients, but it can be managed well with endoscopic balloon dilatation. (C) 2000 by Excerpta Medica, Inc.