Background

Although certain technical aspects of laparoscopic gastric bypass (LRYGB) have been found to impact postoperative outcomes, it is unclear whether surgeons who have changed their technique have experienced improvement in their outcomes.

Methods

Surgeons (n=31) participating in a state-wide bariatric specific quality improvement collaborative were asked to complete a survey on how they perform a typical LRYGB in 2011 and again in 2021. Risk adjusted 30-day complication rates for cases in 2011 were compared to those in 2021 among surgeons who changed their gastrojejunostomy technique from end-to-end anastomosis (EEA) to either a linear staple or handsewn anastomosis (LS/HS).

Results

A total of 13 surgeons (41.9%) changed their technique from EEA to LS/HS. Changes in technique were associated with decreased rates of surgical complications (9.9% in 2011 vs. 6.7% in 2021; p=0.0013), wound infection (4.7% in 2011 vs. 3% in 2021; p=0.0083), and strictures (2.6% in 2011 vs. 0.2% in 2021; p=0.027). In addition, surgeons who changed their technique had a significant increase in overall mean robotic volume (7.6 cases in 2011 vs. 46.8 cases in 2021; p=0.0020) during the study period.

Conclusions

Nearly half of the surgeons changed their gastrojejunostomy technique from circular stapled to handsewn over the course of a decade. These surgeons had significant reduction in postoperative complications, including wound infection and strictures, and were major adopters of robotic surgery.