Reduction of Circular Stapler-Related Wound Infection in Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass, Cleveland Clinic Technique

Circular-stapled anastomosis with trans-oral anvil insertion for the creation of the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass (LRYGBP) is associated with frequent infections at the abdominal wall site where the circular stapler is inserted. Patients who underwent routine LRYGBP over a 1.5-year period at The Cleveland Clinic Foundation without any concomitant procedures were included. After our initial experience with circular-stapled anastomosis-related wound infections, we implemented measures to reduce the infection rate. Prevention measures included chlorhexidine "swish and swallow," a plastic barrier device over the stapler, wound irrigation, loose skin approximation, and placement of loose packing. We compared wound infection rates in patients before ("no prevention") and after ("prevention") implementing these measures. Ninety-one patients with mean age of 42 years and average body mass index of 48 kg/m(2) underwent laparoscopic Roux-en-Y gastric bypass. The infection rate was 30% among the "no prevention" (n = 10) group and 1% in the "prevention" (n = 81) group (p < 0.05). Trocar site infection related to the circular-stapled anastomosis technique can be significantly reduced with simple prevention measures.