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Early experience with computer-mediated flexible circular stapling technique for upper gastrointestinal anastomosis.

Abstract：

BACKGROUND:Creating the proximal anastomosis in laparoscopic biliopancreatic diversion with duodenal switch (LBPD-DS) and Roux-en-Y gastric bypass (LRYGBP) is a critical step in ensuring the success of the procedures. The aim of this study was to assess the safety and efficiency of performing this anastomosis using a flexible, computerized, circular stapling device. METHOD:We prospectively monitored the use of a newly FDA-approved stapling device (SurgASSIST, Power Medical Intervention) for the construction of the proximal anastomosis by a variety of approaches and reviewed the charts of 10 patients. RESULTS:We successfully constructed 9 out of 10 proximal anastomoses: 2 gastro-jejunostomies and 7 duodeno-ileostomies, without any signs of leakage. In 2 patients, the stapling technique involved a transpyloric instrumental passage; both were complicated by the difficulty to pass either the flexible scope or the anvil through the narrow pyloric lumen. In 5 patients, the anvil was placed directly through a duodenotomy and no technical problems were encountered. The median time for performing the proximal anastomosis was 19 minutes (range 9-55). There were no postoperative complications in any patients. CONCLUSIONS:Stapling using the SurgASSIST was feasible and safe for performing laparoscopic anastomoses in bariatric bypass procedures. A duodenotomy for direct placement of the anvil into the postpyloric region seems to be most feasible for duodenoileostomies, while transoral passage of the anvil can be recommended for gastro-jejunostomies. In its current form, we do not recommend transoral placement of the flexible shaft of the SurgASSIST device. Further clinical trials need to be performed for comparison with existing devices.

journal_name

Obes Surg

journal_title

Obesity surgery

authors

Waage A,Gagner M,Feng JJ

doi

10.1381/096089203321136656

subject

Has Abstract

pub_date

2003-02-01 00:00:00

pages

88-94

issue

1

eissn

0960-8923

issn

1708-0428

journal_volume

13

pub_type

杂志文章

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