Anastomotic leak following antecolic versus retrocolic laparoscopic Roux-en-Y gastric bypass for morbid obesity

Michael A. Edwards, Daniel B. Jones, James Ellsmere, Ronit Grinbaum, Benjamin E. Schneider

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: Laparoscopic Roux-en-Y gastric bypass(LRYGBP) is the most commonly performed operation for the treatment of morbid obesity in the United States. Previous reports suggest that postoperative complications may be influenced by Roux limb orientation (antecolic versus retrocolic), although thisremains controversial. The aim of this study was toanalyze our experience with anastomotic leaks following LRYGBP with an antecolic- versus retrocolicrouted Roux limb. Methods: During the 2-year period of June 2003 to June 2005, 353 patients underwent a LRYGBP. 135 were antecolic and 218 retrocolic. All cases were performedby one of three bariatric surgeons. The decisionto perform antecolic versus retrocolic LRYGBP was left to the surgeon's preference. The primary outcome measure was anastomotic leak. Results: Mean follow-up was 28 weeks. There wereno perioperative deaths. Overall complication rate was 16.9%. 17 gastrojejunal leaks (4.8%) were identified, consisting of 12 intraoperative leaks (3.4%) and 5 postoperative leaks (1.4%). Postoperative gastrojejunal leak rate was higher in the antecolic group (P = 0.04). Conclusion: Mortality and complication rates were consistent with reported benchmarks on the efficacy and safety of LRYGBP. Our review suggests that anastomotic leak may be more common after antecolic than after retrocolic LRYGBP for morbid obesity. A prospective randomized study is needed to determine whether antecolically-routed Roux limb is an independent predictor for anastomotic leak following LRYGBP.

Original languageEnglish (US)
Pages (from-to)292-297
Number of pages6
JournalObesity Surgery
Volume17
Issue number3
DOIs
StatePublished - Mar 1 2007

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Anastomotic Leak
Gastric Bypass
Morbid Obesity
Extremities
Bariatrics
Benchmarking
Outcome Assessment (Health Care)
Prospective Studies
Safety
Mortality

Keywords

  • Anastomotic leak
  • Antecolic
  • Complications
  • Laparoscopic Roux-en-Y gastric bypass
  • Morbid obesity
  • Retrocolic

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

Cite this

Anastomotic leak following antecolic versus retrocolic laparoscopic Roux-en-Y gastric bypass for morbid obesity. / Edwards, Michael A.; Jones, Daniel B.; Ellsmere, James; Grinbaum, Ronit; Schneider, Benjamin E.

In: Obesity Surgery, Vol. 17, No. 3, 01.03.2007, p. 292-297.

Research output: Contribution to journalArticle

Edwards, Michael A. ; Jones, Daniel B. ; Ellsmere, James ; Grinbaum, Ronit ; Schneider, Benjamin E. / Anastomotic leak following antecolic versus retrocolic laparoscopic Roux-en-Y gastric bypass for morbid obesity. In: Obesity Surgery. 2007 ; Vol. 17, No. 3. pp. 292-297.
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abstract = "Background: Laparoscopic Roux-en-Y gastric bypass(LRYGBP) is the most commonly performed operation for the treatment of morbid obesity in the United States. Previous reports suggest that postoperative complications may be influenced by Roux limb orientation (antecolic versus retrocolic), although thisremains controversial. The aim of this study was toanalyze our experience with anastomotic leaks following LRYGBP with an antecolic- versus retrocolicrouted Roux limb. Methods: During the 2-year period of June 2003 to June 2005, 353 patients underwent a LRYGBP. 135 were antecolic and 218 retrocolic. All cases were performedby one of three bariatric surgeons. The decisionto perform antecolic versus retrocolic LRYGBP was left to the surgeon's preference. The primary outcome measure was anastomotic leak. Results: Mean follow-up was 28 weeks. There wereno perioperative deaths. Overall complication rate was 16.9{\%}. 17 gastrojejunal leaks (4.8{\%}) were identified, consisting of 12 intraoperative leaks (3.4{\%}) and 5 postoperative leaks (1.4{\%}). Postoperative gastrojejunal leak rate was higher in the antecolic group (P = 0.04). Conclusion: Mortality and complication rates were consistent with reported benchmarks on the efficacy and safety of LRYGBP. Our review suggests that anastomotic leak may be more common after antecolic than after retrocolic LRYGBP for morbid obesity. A prospective randomized study is needed to determine whether antecolically-routed Roux limb is an independent predictor for anastomotic leak following LRYGBP.",
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