BACKGROUND

Hand-sewn intracorporeal anastomosis in laparoscopic mini-gastric bypass (MGB) is considered as a step towards solving the problems of long-term complications of this type of intervention — gastroenteroanastomosis (GEA) ulcers and biliary esophageal reflux. The question of the frequency of early complications in comparison with the classical stapler technique of anastomosis formation is topical question. From the standpoint of the safety profile, the nuances of the intervention technique are very important.

OBJECTIVE

The purpose of the study is to evaluate the safety profile of MGB with hand-sewn and stapler GEA and compare the risks of postoperative complications.

MATERIAL AND METHODS

Prospective study included 209 patients after MGB. In 105 people (study group — MA) the intervention was performed according to the developed technique with a completely manual gastroenteroanastomosis (iMGB), in 104 people (control group — SA) the GEA was formed by the classical stapler method.

RESULTS

The proposed technique of hand-sewn anastomosis (iMGB) made it possible to achieve a decrease in the remaining non-absorbable foreign material in the body by 47% (p<0.001), with their complete absence in the anastomosis zone, despite a slightly longer average operating time. In the MA group it was 20 minutes longer, median time 95 (90—105) vs. 75 (65—80) minutes in SA group (p<0.001). This is due to an increase in the volume of intracorporeal manual suture in the iMGB technique. There were no significant differences in the risks of infectious complications between groups. The overall incidence of early surgical complications of Clavien—Dindo class IIIB—IV in the group of patients with iMGB was more than 2 times lower (2.85% vs. 6.73%).

CONCLUSION

Fully hand-sewn GEA during MGB can reduce the risks of early postoperative surgical complications. Presented iMGB technique, which shows some advantages in terms of safety profile, places higher demands on surgical experience and intracorporeal manual suture skills.