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Anastomotic Leak following Antecolic versus Retrocolic Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity

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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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Authors and Affiliations

  1. Assistant Professor of Surgery, Medical College of Georgia, Augusta, GA, USA

    Michael A. Edwards MD

  2. Associate Professor of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Daniel B. Jones MD

  3. Therapeutic Endoscopy Fellow, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    James Ellsmere MD

  4. Surgical Research Fellow, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Ronit Grinbaum MD

  5. Instructor in Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Shapiro 3C, Boston, MA, 02212, USA

    Benjamin E. Schneider MD

Authors
  1. Michael A. Edwards MD
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  2. Daniel B. Jones MD
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  3. James Ellsmere MD
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  4. Ronit Grinbaum MD
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  5. Benjamin E. Schneider MD
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Correspondence to Benjamin E. Schneider MD.

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Edwards, M.A., Jones, D.B., Ellsmere, J. et al. Anastomotic Leak following Antecolic versus Retrocolic Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity. OBES SURG 17, 292–297 (2007). https://doi.org/10.1007/s11695-007-9048-8

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  • DOI: https://doi.org/10.1007/s11695-007-9048-8

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