A prospective evaluation of intracorporeal laparoscopic small bowel anastomosis during gastric bypass

Background: We evaluated the safety and feasibility of performing a laparos copic intracorporeal end-to-side small bowel anastomosis using a stapling t echnique as part of a Roux-en-Y gastric bypass operation (RYGBP), Methods: 80 consecutive patients who underwent RYGBP with laparoscopic jeju nojejunostomy were evaluated. Operative time and intraoperative and postope rative complications directly related to the jejunojejunostomy anastomosis were recorded. Results: All 80 laparoscopic jejunojejunostomy procedures were successfully performed without conversion to laparotomy. Mean operative time was longer for the first 40 laparoscopic RYGBP than for the last 40 RYGBP (32+/-18 mi n vs 21+/-14 min, respectively, p<0.05). Intraoperative complications were staple-line bleeding (2 patients) and narrowing of the anastomosis (1 patie nt), Postoperative complications were four small bowel obstructions: techni cal narrowing at jejunojejunostomy site (2 patients), angulation of the aff erent limb (1 patient), and food impaction at the jejunojejunostomy anastom osis (1 patient), These four patients underwent successful laparoscopic re- exploration and creation of another jejunojejunostomy proximal to the origi nal anastomosis. There were no small bowel anastomotic leaks, The median ti me to resuming oral diet was 2 days. Conclusions: Laparoscopic jejunojejunostomy as part of the RYGBP operation is a safe and technically feasible procedure. Postoperative small bowel obs truction is a potential complication, which can be prevented by avoiding te chnical narrowing of the afferent limb.