An intraoperative technique to reduce superficial surgical site infections in circular stapler-constructed laparoscopic Roux-en-Y gastric bypass

Yang Zhang, Oscar K. Serrano, W. Scott Melvin, Diego Camacho

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been established as one of the most effective treatments for morbid obesity. Surgical site infections are the most common complication after LRYGB surgery. Objective: To compare the superficial surgical site infections (sSSI) rate before and after the implementation of our intraoperative technique. Setting: Academic medical center. Methods: Our intraoperative technique relies on sterile coverage of the circular stapler, sterile specimen-bag retrieval of the gastrojejunostomy enteric remnant, and port site Penrose drainage. We analyzed our sSSI outcomes before and after implementation of our technique in all LRYGBs performed by a single surgeon from 2009 to 2015. We took into account patient age; sex; baseline body mass index (BMI); smoking status; and co-morbidities such as diabetes, hypertension, and hyperlipidemia. χ2 and multivariate analysis were performed. Results: We performed 486 LRYGBs in 2009-2015. The cohort before implementation of our technique (group 1) included 164 patients (33.7%) and the cohort after implementation (group 2) included 322 patients (66.3%). Both groups were similar in age, sex, smoking status, and rates of diabetes and hyperlipidemia but differed in BMI, operative time, and prevalence of hypertension. Hypertension was not a confounder for sSSI (P = .35). The sSSI rate was 9.15% for group 1 and 3.42% for group 2 (P = .0079). Controlling for BMI and operative time, multivariate analysis revealed a significant reduction in sSSI (odds ratio 2.98 [95% CI 1.33-6.69]) with our technique. Conclusions: We describe a reproducible intraoperative technique that significantly reduces sSSI in LRYGB procedures. Our technique has the potential of hastening postoperative recovery.

Original languageEnglish (US)
JournalSurgery for Obesity and Related Diseases
DOIs
StateAccepted/In press - Nov 6 2015

Fingerprint

Surgical Wound Infection
Gastric Bypass
Body Mass Index
Operative Time
Hypertension
Hyperlipidemias
Multivariate Analysis
Smoking
Morbid Obesity
Drainage
Odds Ratio
Morbidity

Keywords

  • Bariatric Surgery
  • Intraoperative Technique
  • Laparoscopic Roux-en-Y Gastric Bypass
  • Morbid Obesity
  • Surgical Site Infection
  • Wound Infection

ASJC Scopus subject areas

  • Surgery

Cite this

@article{5d7524c4605345f391c183303961f667,
title = "An intraoperative technique to reduce superficial surgical site infections in circular stapler-constructed laparoscopic Roux-en-Y gastric bypass",
abstract = "Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been established as one of the most effective treatments for morbid obesity. Surgical site infections are the most common complication after LRYGB surgery. Objective: To compare the superficial surgical site infections (sSSI) rate before and after the implementation of our intraoperative technique. Setting: Academic medical center. Methods: Our intraoperative technique relies on sterile coverage of the circular stapler, sterile specimen-bag retrieval of the gastrojejunostomy enteric remnant, and port site Penrose drainage. We analyzed our sSSI outcomes before and after implementation of our technique in all LRYGBs performed by a single surgeon from 2009 to 2015. We took into account patient age; sex; baseline body mass index (BMI); smoking status; and co-morbidities such as diabetes, hypertension, and hyperlipidemia. χ2 and multivariate analysis were performed. Results: We performed 486 LRYGBs in 2009-2015. The cohort before implementation of our technique (group 1) included 164 patients (33.7{\%}) and the cohort after implementation (group 2) included 322 patients (66.3{\%}). Both groups were similar in age, sex, smoking status, and rates of diabetes and hyperlipidemia but differed in BMI, operative time, and prevalence of hypertension. Hypertension was not a confounder for sSSI (P = .35). The sSSI rate was 9.15{\%} for group 1 and 3.42{\%} for group 2 (P = .0079). Controlling for BMI and operative time, multivariate analysis revealed a significant reduction in sSSI (odds ratio 2.98 [95{\%} CI 1.33-6.69]) with our technique. Conclusions: We describe a reproducible intraoperative technique that significantly reduces sSSI in LRYGB procedures. Our technique has the potential of hastening postoperative recovery.",
keywords = "Bariatric Surgery, Intraoperative Technique, Laparoscopic Roux-en-Y Gastric Bypass, Morbid Obesity, Surgical Site Infection, Wound Infection",
author = "Yang Zhang and Serrano, {Oscar K.} and Melvin, {W. Scott} and Diego Camacho",
year = "2015",
month = "11",
day = "6",
doi = "10.1016/j.soard.2016.01.003",
language = "English (US)",
journal = "Surgery for Obesity and Related Diseases",
issn = "1550-7289",
publisher = "Elsevier Inc.",

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TY - JOUR

T1 - An intraoperative technique to reduce superficial surgical site infections in circular stapler-constructed laparoscopic Roux-en-Y gastric bypass

AU - Zhang, Yang

AU - Serrano, Oscar K.

AU - Melvin, W. Scott

AU - Camacho, Diego

PY - 2015/11/6

Y1 - 2015/11/6

N2 - Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been established as one of the most effective treatments for morbid obesity. Surgical site infections are the most common complication after LRYGB surgery. Objective: To compare the superficial surgical site infections (sSSI) rate before and after the implementation of our intraoperative technique. Setting: Academic medical center. Methods: Our intraoperative technique relies on sterile coverage of the circular stapler, sterile specimen-bag retrieval of the gastrojejunostomy enteric remnant, and port site Penrose drainage. We analyzed our sSSI outcomes before and after implementation of our technique in all LRYGBs performed by a single surgeon from 2009 to 2015. We took into account patient age; sex; baseline body mass index (BMI); smoking status; and co-morbidities such as diabetes, hypertension, and hyperlipidemia. χ2 and multivariate analysis were performed. Results: We performed 486 LRYGBs in 2009-2015. The cohort before implementation of our technique (group 1) included 164 patients (33.7%) and the cohort after implementation (group 2) included 322 patients (66.3%). Both groups were similar in age, sex, smoking status, and rates of diabetes and hyperlipidemia but differed in BMI, operative time, and prevalence of hypertension. Hypertension was not a confounder for sSSI (P = .35). The sSSI rate was 9.15% for group 1 and 3.42% for group 2 (P = .0079). Controlling for BMI and operative time, multivariate analysis revealed a significant reduction in sSSI (odds ratio 2.98 [95% CI 1.33-6.69]) with our technique. Conclusions: We describe a reproducible intraoperative technique that significantly reduces sSSI in LRYGB procedures. Our technique has the potential of hastening postoperative recovery.

AB - Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been established as one of the most effective treatments for morbid obesity. Surgical site infections are the most common complication after LRYGB surgery. Objective: To compare the superficial surgical site infections (sSSI) rate before and after the implementation of our intraoperative technique. Setting: Academic medical center. Methods: Our intraoperative technique relies on sterile coverage of the circular stapler, sterile specimen-bag retrieval of the gastrojejunostomy enteric remnant, and port site Penrose drainage. We analyzed our sSSI outcomes before and after implementation of our technique in all LRYGBs performed by a single surgeon from 2009 to 2015. We took into account patient age; sex; baseline body mass index (BMI); smoking status; and co-morbidities such as diabetes, hypertension, and hyperlipidemia. χ2 and multivariate analysis were performed. Results: We performed 486 LRYGBs in 2009-2015. The cohort before implementation of our technique (group 1) included 164 patients (33.7%) and the cohort after implementation (group 2) included 322 patients (66.3%). Both groups were similar in age, sex, smoking status, and rates of diabetes and hyperlipidemia but differed in BMI, operative time, and prevalence of hypertension. Hypertension was not a confounder for sSSI (P = .35). The sSSI rate was 9.15% for group 1 and 3.42% for group 2 (P = .0079). Controlling for BMI and operative time, multivariate analysis revealed a significant reduction in sSSI (odds ratio 2.98 [95% CI 1.33-6.69]) with our technique. Conclusions: We describe a reproducible intraoperative technique that significantly reduces sSSI in LRYGB procedures. Our technique has the potential of hastening postoperative recovery.

KW - Bariatric Surgery

KW - Intraoperative Technique

KW - Laparoscopic Roux-en-Y Gastric Bypass

KW - Morbid Obesity

KW - Surgical Site Infection

KW - Wound Infection

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U2 - 10.1016/j.soard.2016.01.003

DO - 10.1016/j.soard.2016.01.003

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JO - Surgery for Obesity and Related Diseases

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SN - 1550-7289

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