Bidirectional Jejunojejunal Anastomosis Prevents Early Small Bowel Obstruction Due to the Kinking After Closure of the Mesenteric Defect in the Laparoscopic Roux-en-Y Gastric Bypass.
BACKGROUND
The closure of the mesenteric defects (CMD) in Roux-en-Y gastric bypass (RYGB) reduces the risk of small bowel obstruction (SBO) due to internal hernia but might be associated with an increased risk of early SBO triggered by the jejunojejunal anastomosis (JJS) kinking. The aim of this study was to assess how enlarging the JJS with a bidirectional linear stapling can aid in avoiding the risk of early SBO by kinking.


MATERIALS AND METHODS
This retrospective cohort study concerns 1327 patients who underwent RYGB with CMD between May 2007 and August 2016. The first 626 patients (group A) had a unidirectional JJS. The following 701 patients (group B) had a bidirectional side-to-side JJS and a hand-sewn closure of the remaining defect. We compared early SBO between the two groups.


RESULTS
Eleven (1.75%) early SBO due to the JJS kinking occurred in group A, whereas none occurred in group B (p = 0.0012). Thirty-nine early postoperative complications happened in group A versus 32 in group B (p = 0.17). Nine (1.2%) digestive bleedings occurred in group B versus two (0.3%) in group A (OR = 4.05 [0.87-18], p = 0.054). Average operating time was 81 min [37-330] in group A and 77 min [33-240] in group B.


CONCLUSION
Enlarging the JJS with a bidirectional linear stapling is associated with a reduced risk of early SBO due to the anastomosis kinking. However, it could be related to an increased risk of digestive bleedings.
['Munier|Pierre|P|http://orcid.org/0000-0002-7306-8343', 'Alratrout|Hefzi|H|', 'Siciliano|Iole|I|', 'Keller|Philippe|P|']
D000328:Adult D000714:Anastomosis, Surgical D005260:Female D015390:Gastric Bypass D006547:Hernia D006801:Humans D007415:Intestinal Obstruction D007421:Intestine, Small D007583:Jejunum D010535:Laparoscopy D008297:Male D008643:Mesentery D008875:Middle Aged D009767:Obesity, Morbid D011183:Postoperative Complications D012189:Retrospective Studies
Jejunojejunal anastomosis Bowel obstruction Kinking Mesenteric defect Roux-en-Y Gastric bypass Postoperative complications Intestinal obstruction Jejunojejunostomy