Faculty Collaboration Database

Evaluating outcomes among surgeons who changed their technique for gastric bypass: a state-wide analysis from 2011 to 2021. Surg Endosc 2023 Nov;37(11):8464-8472

Date

09/23/2023

Pubmed ID

37740112

DOI

10.1007/s00464-023-10434-x

Scopus ID

2-s2.0-85171735300 (requires institutional sign-in at Scopus site)

Abstract

INTRODUCTION: Technical variation exists when performing the gastrojejunostomy during Roux-en-Y gastric bypass (RYGB). However, it is unclear whether changing technique results in improved outcomes or patient harm.

METHODS: Surgeons participating in a state-wide bariatric surgery quality collaborative who completed a survey on how they perform a typical RYGB in 2011 and again in 2021 were included in the analysis (n = 31). Risk-adjusted 30-day complication rates and case characteristics for cases in 2011 were compared to those in 2021 among surgeons who changed their gastrojejunostomy technique from end-to-end anastomosis (EEA) to either a linear staple or handsewn anastomosis (LSA/HSA). In addition, case characteristics and outcomes among surgeons who maintained an EEA technique throughout the study period were assessed.

RESULTS: A total of 15 surgeons (48.3%) changed their technique from EEA to LSA/HSA while 7 surgeons (22.3%) did not. Nine surgeons did LSA or HSA the entire period and therefore were not included. Surgeons who changed their technique had significantly lower rates of surgical complications in 2021 when compared to 2011 (1.9% vs 5.1%, p = 0.0015), including lower rates of wound complications (0.5% vs 2.1%, p = 0.0030) and stricture (0.1% vs 0.5%, p = 0.0533). Likewise, surgeons who did not change their EEA technique, also experienced a decrease in surgical complications (1.8% vs 5.8%, p < 0.0001), wound complications (0.7% vs 2.1%, p < 0.0001) and strictures (0.2% vs 1.2%, p = 0.0006). Surgeons who changed their technique had a significantly higher mean annual robotic bariatric volume in 2021 (30.0 cases vs 4.9 cases, p < 0.0001) when compared to those who did not.

CONCLUSIONS: Surgeons who changed their gastrojejunostomy technique from circular stapled to handsewn demonstrated greater utilization of the robotic platform than those who did not and experienced a similar decrease in adverse events during the study period, despite altering their technique. Surgeons who chose to modify their operative technique may be more likely to adopt newer technologies.

Author List

Hider AM, Johanson H, Bonham AJ, Ghaferi AA, Finks J, Ehlers AP, Carlin AM, Varban OA

Author

Amir Ghaferi MD President, Phys Enterprise & SAD Clinical Affairs in the Medical College Physicians Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Bariatric Surgery
Constriction, Pathologic
Gastrectomy
Gastric Bypass
Humans
Laparoscopy
Obesity, Morbid
Postoperative Complications
Retrospective Studies
Surgeons