Surgical technique in constructing the jejunojejunostomy and the risk of small bowel obstruction after Roux-en-Y gastric bypass

Suzanne Hedberg; Anders Thorell; My Engström; Erik Stenberg; Torsten Olbers

doi:10.1016/j.soard.2022.05.020

Surgical technique in constructing the jejunojejunostomy and the risk of small bowel obstruction after Roux-en-Y gastric bypass

Surg Obes Relat Dis. 2022 Sep;18(9):1151-1159. doi: 10.1016/j.soard.2022.05.020. Epub 2022 May 21.

Authors

Suzanne Hedberg¹, Anders Thorell², My Engström³, Erik Stenberg⁴, Torsten Olbers⁵

Affiliations

¹ Department of Surgery, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery Sahlgrenska/Östra, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: suzanne.hedberg@vgregion.se.
² Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden; Department of Surgery, Ersta Hospital, Stockholm, Sweden.
³ Department of Surgery Sahlgrenska/Östra, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁴ Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
⁵ Department of Surgery, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Biomedical and Clinical Sciences, University of Linköping, Norrköping, Sweden.

PMID: 35752592
DOI: 10.1016/j.soard.2022.05.020

Abstract

Background: Mechanical problems at the level of the jejunojejunostomy (JJ) have been identified as a cause of small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass (RYGB).

Objectives: The objective of the study was to investigate associations between specific surgical techniques used to construct the JJ and the subsequent risk of SBO.

Setting: Nationwide Registry, Sweden.

Methods: The risk of SBO after primary RYGB surgery during 2012-2019 was assessed using data from the Scandinavian Obesity Surgery Registry and the Swedish National Patient Register. The impact of unidirectional or bidirectional stapling and length of the mesenteric division (0, 1-4, or ≥5 cm) at the JJ was analyzed with adjustments for known covariates.

Results: We analyzed outcomes from 23,448 patients (mean follow-up = 4.3 ± 2.2 yr). In multivariate analysis, bidirectional stapling of the JJ was associated with a reduced 30-day risk of SBO (hazard ratio [HR] = .52, 95% confidence interval [CI] = .29-.95, P < .05), whereas limited mesenteric division (1-4 cm) increased the risk of SBO (HR = 1.66, 95% CI = 1.14-2.42, P < .01). The long-term incidence of SBO was increased by bidirectional stapling but unaffected by mesenteric division. However, mesenteric division decreased the long-term risk of SBO in patients with a bidirectionally stapled JJ (1-4 cm, HR = .59, 95% CI = .38-.90, P < .05; ≥5 cm, HR = .30, 95% CI = .14-.65, P < .005).

Conclusions: The surgical technique for construction of the JJ may affect the incidence of SBO after RYGB surgery.

Keywords: Jejunojejunostomy; Laparoscopic Roux-en-Y gastric bypass; RYGB; Small bowel obstruction.

MeSH terms

Gastric Bypass* / adverse effects
Gastric Bypass* / methods
Humans
Intestinal Obstruction* / epidemiology
Intestinal Obstruction* / etiology
Intestinal Obstruction* / surgery
Intestine, Small / surgery
Laparoscopy* / methods
Obesity, Morbid* / complications
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Postoperative Complications / surgery
Retrospective Studies