Early outcome of “Modified Uncut Roux-En-Y” Technique in Gastric Reconstruction Surgery

Loop gastro-Jejunostomy and Roux-en-Y gastro- Jejunostomy, the commonest reconstructions in gastric surgery, are significantly associated with alkaline reflux gastritis and Roux stasis syndrome (RSS) respectively. The Modified Uncut Roux-en-Y (MUREY) technique could be an effective technique in preventing both the conditions. This prospective observational study was designed to evaluate the effectiveness of Modified UREY reconstruction to prevent RSS and Alkaline reflux gastro-esophagitis while avoiding “Staple- line dehiscence”. A total of 47 patients of gastric outlet obstruction, both benign and malignant, undergoing Modified Uncut Roux-en-Y reconstruction with/ without Gastrectomy at BMCH over the span of July 2014 to July 2016, were incorporated in this study. Patients were followed up from the immediate post-operative periods till discharge and postoperatively for 2 months. There was no incidence of bile reflux or bilious vomiting in the follow-up period. There were two (4.3%) incidences of RSS among the 47 patients (P<0.001). Postoperative endoscopy was carried out in 9 patients to assess the integrity of staple line occlusion which revealed normal looking mucosa of upper GIT with an intact staple line occlusion. There was significant decrease in the average Visick score, from 3.5±0.6 (SD) preoperatively to 1.2±0.4(SD) in the post-operative period. Average increase in the body weight at the time of final follow-up was 6.7%±5.1 kg. The Modified “Uncut Roux-En-Y” reconstruction technique is bothfeasible and safe. It is effective in preventing RSS and alkaline reflux gastritis while preventing Staple-line dehiscence and, can be a preferred technique of gastric bypass.J Bangladesh Coll Phys Surg 2018; 36(4): 139-144

Omental Reinforcement for Intraoperative Leak Repairs during Laparoscopic Roux-en-Y Gastric Bypass

Leaks from the gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass (LRYGB) have the potential for significant morbidity and mortality. When intraoperative leaks are discovered, we choose to perform omental reinforcement around the gastrojejunostomy and pouch after suture repair of the leaks. This study examined the hypothesis that omental reinforcement would be useful after intraoperative leaks during LRYGB. Omental reinforcement was performed on gastrojejunostomies, in which leaks were seen, created using a circular stapler during LRYGB. Data were reviewed retrospectively on these patients. There were a total of 387 patients with 32 (8.26%) patients who had a staple line dehiscence or evidence of gastric pouch or gastrojejunostomy leak intraoperatively Leaks/dehiscences were repaired with sutures and then reinforced with omentum. None of these patient developed anastomotic leak postoperatively. Of the other 365 patients, there were four (1.1%) leaks from the gastrojejunostomy and/or gastric pouch. Omental reinforcement may be useful in decreasing the incidence of postoperative leaks when an intraoperative leak is encountered during LRYGB. However, omental reinforcement does not completely prevent a postoperative leak. Consideration of reinforcement with omentum may be given for patients in whom an intraoperative leak is noted.