Compression anastomosis for Roux-en-Y gastric bypass: observations in a large animal model

Background: In the morbidly obese, laparoscopic Roux-en-Y gastric bypass (RYGB) effectively
achieves weight loss with the resolution of co-morbidities. The goal is to create a small-volume
gastric pouch with a narrow gastrojejunal anastomosis (GJA). The procedure is associated with a
GJA stricture rate of approximately 3%. The use of a compression anastomotic device to create a
sutureless gastrointestinal anastomosis, replacing sutures or staples, might reduce tissue trauma and
improve the GJA patency rate. A temperature-dependent, memory-shape, Nitinol Compression
Anastomosis Clip (CAC) has been successfully used in intestinal anastomoses. Compression of the
entrapped bowel leads to necrosis, with device expulsion after 7–10 days.
Methods: We designed a pilot animal model study of open RYGB to examine the clip’s safety in
the performance of upper gastrointestinal anastomoses. Six 40-kg female pigs underwent RYGB.
Group 1 (n  3) underwent GJA with the CAC and a stapled jejunojejunal anastomosis (JJA). Group
2 (n  3) underwent GJA and JJA with the CAC. One pig from each group was euthanized at 1,
4, and 8 weeks postoperatively.
Results: Two pigs, one from each group, developed gastroparesis. At autopsy, all anastomoses were
patent; the mean GJA diameter with the CAC was 1.6 cm (range 0.6 –3), the mean JJA diameter with
the stapler was 3.8 cm (range 35–40), and the mean JJA diameter with the CAC was 3 cm (range 3–3.2).
Anastomotic burst pressures were similar between the stapled and CAC anastomoses. The device was
passed per rectum by postoperative day 9 (range 8–12). Histologic examination of the CAC anastomoses
demonstrated a complete mucosal lining with no evidence of stricture formation at 2 months.
Conclusion: The results of this small animal study have demonstrated the safety of sutureless
compression anastomoses in an animal model of open RYGB. (Surg Obes Relat Dis 2008;4:
115–121.) © 2008 American Society for Metabolic and Bariatric Surgery. All rights reserved.

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