Total Stapled, Total Intra-abdominal (TSTI) laparoscopic Roux-en-Y gastric bypass: One leak in 1,000 cases

Background: Variations in technique of laparoscopic Roux-en-Y gastric bypass (LRYGBP) have been reported. These changes, mainly in the construction of the gastro-jejunostomy, are intended to decrease complications. Methods: 1,000 consecutive LRYGBPs were performed using the Total Stapled Total Intra-abdominal (TSTI) technique antecolic and antegastric approach. Technical details and results, including perioperative morbidity and mortality, are reported. Results: Although the correction or improvement of the most serious co-morbidities with the use of the TSTI technique were similar to results reported by other gastric bypass surgeons, we noted a considerable difference in the development of leaks using this surgical approach. Current literature on gastric bypass reports a 2-5% incidence of leaks. Using the TSTI approach, the incidence of leaks at our facility was 0.1% (one in 1,000 cases). After analysis of the factors involved, it was concluded that the use of the antecolic and antegastric approach in gastric bypass, as described in the TSTI, should be an important consideration by the surgeon. This technique, which uses a circular stapler, was found to be easy to perform while maintaining a reproducible, controlled opening of the anastomosis. Conclusion: Although this was a non-randomized study, the results found a considerable improvement in the incidence of morbidity and mortality, and a remarkable decrease in the frequency of leaks.