Anastomotic leak following antecolic versus retrocolic laparoscopic Roux-en-Y gastric bypass for morbid obesity

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is the most commonly performed operation for the treatment of morbid obesity in the United States. Previous reports suggest that postoperative complications may be influenced by Roux limb orientation (antecolic versus retrocolic), although this remains controversial. The aim of this study was to analyze our experience with anastomotic leaks following LRYGBP with an antecolic- versus retrocolic-routed Roux limb. Methods: During the 2-year period of June 2003 to June 2005, 353 patients underwent a LRYGBP. 135 were antecolic and 218 retrocolic. All cases were performed by one of three bariatric surgeons. The decision to perform antecolic versus retrocolic LRYGBP was left to the surgeon's preference. The primary outcome measure was anastomotic leak. Results: Mean follow-up was 28 weeks. There were no perioperative deaths. Overall complication rate was 16.9%. 17 gastrojejunal leaks (4.8%) were identified, consisting of 12 intraoperative leaks (3.4%) and 5 postoperative leaks (1.4%). Postoperative gastrojejunal leak rate was higher in the antecolic group (P=0.04). Conclusion: Mortality and complication rates were consistent with reported benchmarks on the efficacy and safety of LRYGBP. Our review suggests that anastomotic leak may be more common after antecolic than after retrocolic LRYGBP for morbid obesity. A prospective randomized study is needed to determine whether antecolically-routed Roux limb is an independent predictor for anastomotic leak following LRYGBP.