Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 2/2010

01-02-2010 | Research Article

Reduction of Circular Stapler-Related Wound Infection in Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass, Cleveland Clinic Technique

Authors: Fahad Alasfar, Adheesh Sabnis, Rockson Liu, Bipan Chand

Published in: Obesity Surgery | Issue 2/2010

Login to get access

Abstract

Background

Circular-stapled anastomosis with trans-oral anvil insertion for the creation of the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass (LRYGBP) is associated with frequent infections at the abdominal wall site where the circular stapler is inserted.

Methods

Patients who underwent routine LRYGBP over a 1.5-year period at The Cleveland Clinic Foundation without any concomitant procedures were included. After our initial experience with circular-stapled anastomosis-related wound infections, we implemented measures to reduce the infection rate. Prevention measures included chlorhexidine “swish and swallow,” a plastic barrier device over the stapler, wound irrigation, loose skin approximation, and placement of loose packing. We compared wound infection rates in patients before (“no prevention”) and after (“prevention”) implementing these measures.

Results

Ninety-one patients with mean age of 42 years and average body mass index of 48 kg/m2 underwent laparoscopic Roux-en-Y gastric bypass. The infection rate was 30% among the “no prevention” (n = 10) group and 1% in the “prevention” (n = 81) group (p < 0.05).

Conclusions

Trocar site infection related to the circular-stapled anastomosis technique can be significantly reduced with simple prevention measures.
Literature
1.
Gonzalez R, Lin E, Venkatesh KR, et al. Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques. Arch Surg 2003;138:181–4.CrossRefPubMed
2.
3.
Sturm R. The effects of obesity, smoking, and drinking on medical problems and costs. Obesity outranks both smoking and drinking in its deleterious effects on health and health costs. Health Aff (Millwood) 2002;21:245–53.CrossRef
4.
Zimmermann-Belsing T, Feldt-Rasmussen U. Obesity: the new worldwide epidemic threat to general health and our complete lack of effective treatment. Endocrinology 2004;145:1501–2.CrossRefPubMed
5.
6.
Christou NV, Jarand J, Sylvestre JL, et al. Analysis of the incidence and risk factors for wound infections in open bariatric surgery. Obes Surg 2004;14(1):16–22.CrossRefPubMed
7.
See C, Carter PL, Elliott D, et al. An institutional experience with laparoscopic gastric bypass complications seen in the first year compared with open gastric bypass complications during the same period. Am J Surg 2002;183:533–8.CrossRefPubMed
8.
Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: Preliminary report of five cases. Obes Surg 1994;4:353–7.CrossRefPubMed
9.
Westling A, Gustavsson S. Laparoscopic vs open Roux-en-Y gastric bypass: a prospective, randomized trial. Obes Surg 2001;11:284–92.CrossRefPubMed
10.
Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 2001;243(3):279–89. Sep.CrossRef
11.
Howard JM, Baker WF, Cullberston WR. National Academy of Sciences–National Research Council, Division of Medical Sciences: post-operative wound infections: the influence of ultraviolet irradiation of the operating room and various other factors. Ann Surg 1964;160(suppl.2):1–192.
12.
Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000;232:515–29.CrossRefPubMed
13.
Shope TR, Cooney RN, McLeod J, et al. Early results after laparoscopic gastric bypass: EEA vs GIA stapled gastrojejunal anastomosis. Obes Surg 2003;13:355–9.CrossRefPubMed
14.
Teixeira JA, Borao FJ, Thomas TA, et al. An alternative technique for creating the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass: experience with 28 consecutive patients. Obes Surg 2000;10:240–4.CrossRefPubMed
15.
Sreenivasan PK, Gittins E. The effects of a chlorhexidine mouthrinse on culturable microorganisms of the tongue and saliva. Microbiol Res 2004;159:365–70.CrossRefPubMed
16.
17.
Sookhai S, Redmond HP, Deasy JM. Impervious wound-edge protector to reduce postoperative wound infection: a randomised, controlled trial. Lancet 1999;353:1585.CrossRefPubMed
18.
Harling R, Moorjani N, Perry C, et al. A prospective, randomised trial of prophylactic antibiotics versus bag extraction in the prophylaxis of wound infection in laparoscopic cholecystectomy. Ann R Coll Surg Engl 2000;82:408–10.PubMed
19.
Brown LL, Shelton HT, Bornside GH, et al. Evaluation of wound irrigation by pulsatile jet and conventional methods. Ann Surg 1978;187:170–3.CrossRefPubMed
20.
Bender JS. Factors influencing outcome in delayed primary closure of contaminated abdominal wounds: a prospective analysis of 181 consecutive patients. Am Surg 2003;69:252–5. discussion 255–256.PubMed
21.
Grosfeld JL, Solit RW. Prevention of wound infection in perforated appendicitis: experience with delayed primary wound closure. Ann Surg 1968;168:891–5.PubMedCrossRef
22.
McLachlin AD, Wall W. Delayed primary closure of the skin and subcutaneous tissue in abdominal surgery. Can J Surg 1976;19:37–40.PubMed
Metadata
Title
Reduction of Circular Stapler-Related Wound Infection in Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass, Cleveland Clinic Technique
Authors
Fahad Alasfar
Adheesh Sabnis
Rockson Liu
Bipan Chand
Publication date
01-02-2010
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 2/2010
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-008-9708-3

Other articles of this Issue 2/2010

Obesity Surgery 2/2010 Go to the issue

Clinical Research

Discrepancy Between Ideal and Realistic Goal Weights in Three Bariatric Procedures: Who Is Likely to Be Unrealistic?

Technical Innovation

Transumbilical Sleeve Gastrectomy

Case Report

Translumenal Endoscopic Drainage of Abdominal Abscess Due to Early Migration of Adjustable Gastric Band

Research Article

Nutritional Assessments of Patients with Non-alcoholic Fatty Liver Disease

Research Article

Nutritional Management of Weight Regain After Bariatric Surgery

Case Report

Barrett’s Esophagus: A Late Complication of Laparoscopic Adjustable Gastric Banding