A biodegradeable membrane from porcine intestinal submucosa to reinforce the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass: Preliminary report

Background: A Silastic ring has been used to prevent dilation of the gastro jejunostomy in Roux-en-Y gastric bypass (RYGBP), The use of a bio-membrane may prevent dilation of the anastomosis without the risks associated with p rostheses. The aim of this study was to evaluate the feasibility and safety of applying such a bio-membrane around the gastrojejunostomy in Laparoscop ic RYGBP (LRYGBP). Methods: We used a new bio-membrane, that is derived from porcine small int estinal submucosa (SIS) and acts as a scaffolding for the ingrowth of conne ctive tissue. Over a 4-month period, 14 LRYGBP patients had their proximal anastomosis wrapped with 10 x 2.5 cm SIS by a single surgeon. We compared t hese patients to a control group of LRYGBP patients matched for BMI. Results: The average age of the patients was 35.0 years (control group: 45. 1 years),The patients had a mean initial BMI of 44.7 kg/m(2) (+/-5.9) stand ard error, and the control subjects had a mean initial BMI of 46.7 kg/m(2) (+/-6.5). SIS application took a mean time of 11 (+/-3) minutes without any intraoperative complication. The median hospital stay was 3.5 days in the experimental group and 3.7 days in controls. Three patients developed a sym ptomatic stenosis at the gastrojejunostomy following surgery. In the contro l group there were two stenoses, At an average followup of 87 days (control s: 95 days), the mean reduction in BMI was 7.8 (+/-0.8) kg/m(2) [controls 8 .6 kg/m(2) (+/-1.5)]. Conclusion: Application of SIS around the gastrojejunostomy in patients und ergoing LRYGBP is feasible and safe. Further follow-up is required, however , to evaluate the effectiveness in preventing dilation of the anastomosis.