Estudo prospectivo randomizado controlado do fechamento de anastomose gastrojejunal em BGYR com fio absorvível e inabsorvível

Abstract

Obesity represents a multifactorial disease that causes serious public health problems. There are 2.0 billion overweight and obese people in the world; Brazil is the fifth in the world ranking. The Gastric Bypass in Y-de-Roux (GBYR) is currently the most performed technique in Brazil. Gastrojejunal anastomosis (GJA) directly influences the restrictive factor of bariatric surgery by delaying the progression of food. Suturing is a technique that has been used for at least 4,000 years; it has evolved in terms of the materials chosen. In this respect, configuration, handling, tension strength and tissue reaction are inherent properties of sutures. Sutures are classified according to their degradation properties. As an example of absorbable thread, the suture thread made of polyester (p-dioxanone, PDS II®) stands out. The sutures performed by the ETHIBOND EXCEL® polyester thread are uniformly coated with polybutylate, being a biologically inert, non-absorbable compound. Objectives: This study aimed, through a prospective and randomized study, to analyze the influence on the size of the gastrojejunal anastomosis performed in Roux-en-Y gastric bypass surgery, as well as the main complications with the use of absorbable or non-absorbable thread. Methods: This study followed a prospective and randomized clinical trial, initially with 40 participants; 37 participants were selected based on the inclusion and exclusion criteria; 19 of whom underwent gastrojejunostomy closure with an absorbable polydioxanone suture (PDS II®), and 18 with non-absorbable ETHIBOND® thread. The inclusion criteria were patients who underwent Roux-en-Y gastric bypass surgery, according to the CFM bariatric surgery indication criteria. As an exclusion, there were patients who had an adverse reaction to anesthesia during surgery, requiring surgery interruption, gastric pouch made with more or less 3 staples, leakage of Methylene Blue during the intraoperative test, and there is a need to reinforce the closure gastrojejunostomy, either with absorbable or non-absorbable thread, regardless of the reason. The surgeries were performed at the Beneficência Portuguesa Hospital, São José do Rio Preto - SP. Statistical analysis was performed using the ANOVA and logistic regression tools, with p <0.05 with statistical significance (95% CI). Results: General complications and upper digestive endoscopy (UDE) were less frequent at the end of 12 months in both groups. At the end of 12 months, the number of complications of the Inb thread decreased considerably, while the number of complications of the Abs thread showed an increase in other complications, including marginal ulcer and intrusive thread. Despite this, there was no significant difference between groups in terms of total weight loss. There was no statistically significant difference between the final values of the anastomotic diameter. Still, the percentage of weight loss over the 12 months was 33.77 ± 6.97% for the Inb group and 36.10 ± 4.89% for the Abs group; with no significant difference (p <0.05). Conclusion: Both suture threads (Inb and Abs) have presented similar complications, and non-significant differences between weight, gastrojejunal anastomosis and pouch values were observed.