Reinforce Gastrojejunostomy in Laparoscopic Roux-en-Y Gastric Bypass
About Dilation Prevention
| Bariatric Surgery information Reinforce Gastrojejunostomy in Laparoscopic Roux-en-Y Gastric Bypass |
About Dilation Prevention |
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Taking Posterior Rectus Sheath Laparoscopically to Reinforce the Gastrojejunostomy
in The Roux-en-Y gastric bypass (RYGBP) is now performed laparoscopically widely with low morbidity and mortality. However, in some cases long-term adequate weight loss is not satisfied because of dilatation of the gastrojejunostomy. Therefore, a prosthetic material and bio-membranes have been used to prevent dilatation. In this study, we used posterior rectus sheath by laparoscopy, to evaluate feasibility and safety of the procedure. Method 20 Yorkshire pigs, under general anesthesia, had a standard laparoscopic RYGBP. In addition, 10 had their gastrojejunostomy anastomosis wrapped with 2x10 cm posterior rectus sheath. Clinical and operative outcome after operation were compared with the control group of laparoscopic Roux-en-Y gastric bypass cases. Results The median weight of the pigs was 46.1 kg (range 42-51) in the posterior rectus sheath-applied group and 45.2 kg (range 42-49) in the control group. All gastrojejunostomies in the posterior rectus sheath-applied group were successfully reinforced laparoscopically. Both groups loss weight compared with their normal growth weight, but there was no significant difference in the median weight loss between the two groups. Two pigs in the posterior rectus sheath-applied group developed a stenosis at the gastrojejunostomy anastomosis following Roux-en-Y gastric bypass. All pigs in the posterior rectus sheath-applied group were found to develop hypertrophic smooth muscle and connective tissue scarring at the gastrojejunostomy on histologic examination. Conclusion Laparoscopic application of posterior rectus sheath around the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass is feasible and safe. The sheath-applied group developed stenosis and connective tissue scarring. Additional research is needed to evaluate effectiveness in preventing dilation of the anastomosis. Source: Surgery to Reduce Obesity |