TY - JOUR
T1 - Decreasing Surgical Site Infection Associated with the Use of Circular Staplers During Roux-En-Y Gastric Bypass
AU - Cabrera, Ana T.Garcia
AU - Romero-Velez, Gustavo
AU - Pereira, Xavier
AU - Vazzana, Joseph T.
AU - Camacho, Diego R.
N1 - Publisher Copyright:
© 2022 by SLS, Society of Laparoscopic & Robotic Surgeons.
PY - 2022
Y1 - 2022
N2 - Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been established as a leading treatment of obesity. Surgical site infections (SSIs) remain the most common complication. Objective: To compare the incidence of SSIs before and after the implementation of our technique. Methods: Our intraoperative technique limits enteric contact with the abdominal wall through a wound protector at the end-to-end anastomosis stapler port site, with enteric retrieval with a specimen bag followed by betadine irrigation. We analyzed our SSIs outcomes before and after implementation of our technique in all RYGB and laparoscopic sleeve-to-bypass conversions at our institution performed by two providers between January 1, 2009 to December 31, 2011 and January 1, 2019 to December 31, 2021. We compared patient age, sex, body mass index, American Society of Anesthesiologists class; and comorbidities including hypertension, diabetes, and hyperlipidemia. The x2, Fischer exact, Wilcoxon Rank Sum tests, and multivariate analysis were performed. Results: Four hundred twenty-nine patients underwent LRYGB and sleeve-to-bypass conversion during the two study periods. Group 1 (162 patients, 37.76%) all underwent RYGB. Group 2 (267 patients, 62.24%) of whom 199 underwent RYGB and 68 underwent a laparoscopic sleeve-to-bypass conversion. The SSI rate was 9.26% in Group 1 and 2.62% in Group 2 (p = 0.002514). Statistical significance was also noted for operating room time (137 min vs 123 min, p = 0.02) and hospital length of stay (2 – 3 interquartile range vs 1 – 2 interquartile range, p = 0.04). Conclusion: We propose a safe, reproducible technique that significantly reduces SSI rates during LRYGB.
AB - Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been established as a leading treatment of obesity. Surgical site infections (SSIs) remain the most common complication. Objective: To compare the incidence of SSIs before and after the implementation of our technique. Methods: Our intraoperative technique limits enteric contact with the abdominal wall through a wound protector at the end-to-end anastomosis stapler port site, with enteric retrieval with a specimen bag followed by betadine irrigation. We analyzed our SSIs outcomes before and after implementation of our technique in all RYGB and laparoscopic sleeve-to-bypass conversions at our institution performed by two providers between January 1, 2009 to December 31, 2011 and January 1, 2019 to December 31, 2021. We compared patient age, sex, body mass index, American Society of Anesthesiologists class; and comorbidities including hypertension, diabetes, and hyperlipidemia. The x2, Fischer exact, Wilcoxon Rank Sum tests, and multivariate analysis were performed. Results: Four hundred twenty-nine patients underwent LRYGB and sleeve-to-bypass conversion during the two study periods. Group 1 (162 patients, 37.76%) all underwent RYGB. Group 2 (267 patients, 62.24%) of whom 199 underwent RYGB and 68 underwent a laparoscopic sleeve-to-bypass conversion. The SSI rate was 9.26% in Group 1 and 2.62% in Group 2 (p = 0.002514). Statistical significance was also noted for operating room time (137 min vs 123 min, p = 0.02) and hospital length of stay (2 – 3 interquartile range vs 1 – 2 interquartile range, p = 0.04). Conclusion: We propose a safe, reproducible technique that significantly reduces SSI rates during LRYGB.
KW - Circular stapler
KW - EEA
KW - Gastric bypass
KW - Surgical site infection
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U2 - 10.4293/JSLS.2022.00056
DO - 10.4293/JSLS.2022.00056
M3 - Article
C2 - 36721733
AN - SCOPUS:85147186675
SN - 1086-8089
VL - 26
JO - Journal of the Society of Laparoendoscopic Surgeons
JF - Journal of the Society of Laparoendoscopic Surgeons
IS - 4
M1 - e2022.00056
ER -