H Mason Hedberg1, Alexander Trenk2, Michael B Ujiki2. 1. Department of Surgery, University of Chicago Medical Center, NorthShore University HealthSystem, Evanston, Illinois. Electronic address: herbert.hedberg@uchospitals.edu. 2. Department of Surgery, University of Chicago Medical Center, NorthShore University HealthSystem, Evanston, Illinois.
Abstract
BACKGROUND: Weight regain after Roux-en-Y gastric bypass affects up to 30% of individuals. A dilated gastrojejunostomy contributes to regain through decreased restriction. Endoscopic gastrojejunostomy revision is a safe alternative to revisional surgery. There is evidence that technique affects outcome, but the mechanical properties of various sutured repairs have not been evaluated. OBJECTIVE: To compare different suture patterns for endoscopic gastrojejunostomy revision using an ex vivo porcine model. SETTING: University hospital, United States; surgical laboratory. METHODS: Gastrojejunostomoies were created between porcine stomach and a small intestine with a circular stapler. The gastrojejunostomy was revised with 1 of 5 suture patterns: simple-interrupted, vest-over-pants, figure-of-eight, purse-string, or hairpin. After revision, the stomachs were pressurized with water under continuous manometric monitoring. Failure pressure was recorded when either the hardware or the tissue became compromised. RESULTS: Procedure time, failure type, and pressure were recorded for 8 trials per pattern. Average failure pressures from lowest to highest were simple interrupted, vest-over-pants, figure-of-eight, purse-string, and hairpin. By analysis of variance, the failure pressures were different (P<.01). The suture-anchor connection failed 16 times, the tissue tore 24 times, and failure pressure of the former was lower (P<.01). Failure pressure was moderately correlated with number of bites-per-suture. The purse-string pattern was the fastest to perform (P<.05). CONCLUSION: This study successfully used an ex vivo porcine model to compare performance of suture patterns used for endoscopic gastrojejunostomy revision. More bites-per-suture seems to improve durability by reducing tension on the suture-anchor. For this reason, the interrupted technique is inferior and should likely be abandoned in favor of patterns with more bites-per-suture.
BACKGROUND: Weight regain after Roux-en-Y gastric bypass affects up to 30% of individuals. A dilated gastrojejunostomy contributes to regain through decreased restriction. Endoscopic gastrojejunostomy revision is a safe alternative to revisional surgery. There is evidence that technique affects outcome, but the mechanical properties of various sutured repairs have not been evaluated. OBJECTIVE: To compare different suture patterns for endoscopic gastrojejunostomy revision using an ex vivo porcine model. SETTING: University hospital, United States; surgical laboratory. METHODS: Gastrojejunostomoies were created between porcine stomach and a small intestine with a circular stapler. The gastrojejunostomy was revised with 1 of 5 suture patterns: simple-interrupted, vest-over-pants, figure-of-eight, purse-string, or hairpin. After revision, the stomachs were pressurized with water under continuous manometric monitoring. Failure pressure was recorded when either the hardware or the tissue became compromised. RESULTS: Procedure time, failure type, and pressure were recorded for 8 trials per pattern. Average failure pressures from lowest to highest were simple interrupted, vest-over-pants, figure-of-eight, purse-string, and hairpin. By analysis of variance, the failure pressures were different (P<.01). The suture-anchor connection failed 16 times, the tissue tore 24 times, and failure pressure of the former was lower (P<.01). Failure pressure was moderately correlated with number of bites-per-suture. The purse-string pattern was the fastest to perform (P<.05). CONCLUSION: This study successfully used an ex vivo porcine model to compare performance of suture patterns used for endoscopic gastrojejunostomy revision. More bites-per-suture seems to improve durability by reducing tension on the suture-anchor. For this reason, the interrupted technique is inferior and should likely be abandoned in favor of patterns with more bites-per-suture.
Authors: Zachary M Callahan; Bailey Su; Kristine Kuchta; Eliza Conaty; Stephanie Novak; John Linn; Faris M Murad; JoAnn Carbray; Michael Ujiki Journal: J Gastrointest Surg Date: 2019-12-10 Impact factor: 3.452