XXXX rates in antecolic/antegastric versus retrocolic/retrogastric Roux limb gastric bypass: a meta-analysis.

@entity1 @entity154 @entity1744 @entity547
BACKGROUND: Previous literature is varied with regard to rates of @entity1744 after laparoscopic Roux-en-Y gastric bypass (LRYGB). Internal herniation through @entity154 is a common cause of @entity1744 . There are advantages and disadvantages to routing the Roux limb via a retrocolic/retrogastric (RC/RG) versus an antecolic/antegastric (AC/AG) position. OBJECTIVE: To review the literature comparing obstruction rates in RYGB using the antecolic versus retrocolic approach. SETTING: Community-based integrated multispecialty health system with a teaching hospital serving 19 counties over a 3-state region. METHODS: A literature search for articles published from 1994-2013 was completed. Articles were included if they reported an n>25, Roux limb route, obstruction rate by route, and follow-up duration. Statistical analysis included   (2) test by @entity1 number. RESULTS: The initial search identified 241 articles; 8 met inclusion criteria. There were 4805 @entity1 in the AC/AG group, and 2238 in the RC/RG group. Follow-up ranged from 0 to 68 months. A linear stapled technique was reported in 4231 (88%) @entity1 in the AC/AG group and 1541 (69%) of RC/RG group. Handsewn closure of @entity154 was reported in 2152 (45%) @entity1 in the AC/AG group and 1012 (45%) @entity1 in the RC/RG group. @entity1744 occurred in 68 (1.4%) @entity1 in the AC/AG group and 117 (5.2%) @entity1 in the RC/RG group (P<.001). Internal @entity547 were reported in 65 (1.3%) @entity1 in the AC/AG group and 52 (2.3%) @entity1 in the RC/RG group (P<.001). Two mortalities were reported in the AC/AG group. CONCLUSIONS: Increased rates of @entity1744 were observed in the RC/RG group compared with the AC/AG group. A prospective, randomized trial would be necessary to definitively determine the impact of Roux limb position and routine closure of @entity154 on @entity1744 rates after gastric bypass.
