Omental Wrap Use During Gastric Bypass
Does an Omental Wrap over the Gastro-jejunostomy Reduce the Incidence of Stoma Stenosis after Laparoscopic Gastric Bypass? A Randomized Prospective Trial.
J K Champion MD, Mike Williams MD. Emory-Dunwoody Medical Center, Atlanta GA.
Presented at ASBS 2005
This paper reports the outcomes of a trial of utilizing an omental wrap over the gastro-jejunostomy (GJ) during laparoscopic Gastric Bypass to prevent liver adhesions and angulation to reduce the incidence of stoma stenosis.
100 consecutive patients were prospectively randomized to undergo an ante-colic (AC) lap Gastric Bypass with or without a GJ omental wrap and 97 were completed. The limb was passed through an omental window in 58 and over the omentum in 39. There were 74 females and 23 males, with a mean age of 43± 10.8, weight of 139.5± 29.4 Kg, and BMI of 49± 13.7. Statistical significance was determined by Chi Square, Levine’s test and Fisher’s exact test with p≤ .05.
Groups were similar for gender, age, pre-op weight and BMI. Mean follow-up was 9.5 months. There were four stoma stenosis requiring dilation in each cohort which was not significant (p= 1.0). Comparison of groups based on passing the AC limb with or without a window revealed the groups were similar for gender, age, and distribution of omental wraps, but the non window cohort had a higher incidence of stoma stenosis (10.3% vs. 6.9%) despite demonstrating a significantly lower weight and BMI (p< .001).
An omental wrap over the GJ didn’t reduce the incidence of stoma stenosis suggesting angulation and external scarring are not contributing factors after laparoscopic Gastric Bypass. The incidence of stoma stenosis was higher if the AC limb was passed over the omentum without a window.