TY - JOUR
T1 - Early results after laparoscopic gastric bypass
T2 - EEA vs GIA stapled gastrojejunal anastomosis
AU - Shope, Timothy R.
AU - Cooney, Robert N.
AU - McLeod, Janelle
AU - Miller, Cynthia A.
AU - Haluck, Randy S.
N1 - Funding Information:
Fusidic acid, an antibacterial steroidal antibiotic, produced by Fusidum coccineum, was first isolated by Godtfredsen et al. [l] and tentatively characterized by Godtfredsen and Vangedal [2]. The three antibacterial steroid antibiotics, helvolic acid, fusidic acid and cephalosporin P,, are chemically related. Preliminary work by Harvey et al. [3] and Yamaki [4] showed that fusidic acid inhibits protein synthesis in whole cells and synthesis directed by both polyuridylic acid and endogenous messenger in cell-free extracts of various bacteria. Further work by Harvey et al. [5] has shown that fusidic acid affects the final polymerization of amino acids after formation of the ternary complex (polyribosomes with bound phenylalanyl S-RNA). Fusi-die acid stops the movement of aminoacyl-or peptidyl-tRNA from the acceptor site to the donor site even if the donor site is empty [6]. Fusidic acid also stabilizes both prokaryotic [7] and eukaryotic [8] ribosome-translocation factor-GDP complexes while allowing a single round of GTP hydrolysis and translocation. Okura et al. [9] and Willie et al. [lo] have reported that sodium fusidate and the sodium salt of 24,25_dihydrofusidic acid, respectively, inhibit polypeptide chain elongation by binding to the ribosome-elongation factor-G-GDP complex, thereby preventing its dissociation. Active cation transport across the cell membrane is a function of Na+, K’-ATPase. This complex enzyme system can also be inhibited by fusidic acid [ll]. Furthermore, steroids of the fusidane family structurally resemble the bile salts, which act as alimentary biodetergents [12, 131. Several derivatives of fusidic acid are similar in chemical and biophysical properties to bile *This research was supported in part by grants from the National Institutes of Health (AM 10,334 and HD 51129). P. G. wishes to acknowledge the receipt of a NATO Science Fellowship.
PY - 2003/6/1
Y1 - 2003/6/1
N2 - Background: Various surgical techniques have been successfully applied to isolated Roux-en-Y gastric bypass (RYGBP). Many surgeons rely on stapling devices for the gastrojejunal (GJ) anastomosis. Early follow-up results were compared for two laparoscopic techniques for GJ anastomosis: circular end-to-end (EEA) and linear cutting (GIA) staplers. Methods: Medical charts were retrospectively reviewed of all patients who had undergone stapled GJ anastomosis for isolated RYGBP over a 2-year period. The jejunal limb used for GJ anastomosis was fashioned at 1 cm / unit body mass index (BMI). Patients were grouped by GJ anastomotic technique, EEA or GIA, and the results compared. Results: 61 patients underwent RYGBP (EEA=32; GIA=29), with no differences in preoperative BMI or co-morbidities. Mean (±SD) operative time was shorter for the GIA group (EEA=180±56.1 minutes; GIA=145.3±27.9 minutes, P=-0.003). There were 2 early re-operations in the GIA group for anastomotic leaks. Postoperative complications were not statistically different; however, there was an increased incidence of wound infections in the EEA group vs the GIA group (21.9% vs 6.9%, P=0.08). Follow-up at 6-8 months revealed an average percent excess weight loss of 46.7%±12.2% for EEA and 51.4%±10.7% for GIA (P=0.25). Length of stay, total hospital costs and operating-room costs were similar (P=-0.34, 0.53 and 0.96 respectively). Conclusion: Operative time was significantly shorter in the GIA group. Complications, length of stay, weight loss and costs were similar between the groups. Selection of anastomotic technique may be based on surgeon preference, operative time, and potential for serious complications.
AB - Background: Various surgical techniques have been successfully applied to isolated Roux-en-Y gastric bypass (RYGBP). Many surgeons rely on stapling devices for the gastrojejunal (GJ) anastomosis. Early follow-up results were compared for two laparoscopic techniques for GJ anastomosis: circular end-to-end (EEA) and linear cutting (GIA) staplers. Methods: Medical charts were retrospectively reviewed of all patients who had undergone stapled GJ anastomosis for isolated RYGBP over a 2-year period. The jejunal limb used for GJ anastomosis was fashioned at 1 cm / unit body mass index (BMI). Patients were grouped by GJ anastomotic technique, EEA or GIA, and the results compared. Results: 61 patients underwent RYGBP (EEA=32; GIA=29), with no differences in preoperative BMI or co-morbidities. Mean (±SD) operative time was shorter for the GIA group (EEA=180±56.1 minutes; GIA=145.3±27.9 minutes, P=-0.003). There were 2 early re-operations in the GIA group for anastomotic leaks. Postoperative complications were not statistically different; however, there was an increased incidence of wound infections in the EEA group vs the GIA group (21.9% vs 6.9%, P=0.08). Follow-up at 6-8 months revealed an average percent excess weight loss of 46.7%±12.2% for EEA and 51.4%±10.7% for GIA (P=0.25). Length of stay, total hospital costs and operating-room costs were similar (P=-0.34, 0.53 and 0.96 respectively). Conclusion: Operative time was significantly shorter in the GIA group. Complications, length of stay, weight loss and costs were similar between the groups. Selection of anastomotic technique may be based on surgeon preference, operative time, and potential for serious complications.
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U2 - 10.1381/096089203765887651
DO - 10.1381/096089203765887651
M3 - Article
C2 - 12841893
AN - SCOPUS:0037780750
SN - 0960-8923
VL - 13
SP - 355
EP - 359
JO - Obesity Surgery
JF - Obesity Surgery
IS - 3
ER -
