ITALIAN SOCIETY FOR THE SURGERY OF OBESITY ABSTRACTS OF THE 14TH NATIONAL CONGRESS FLORENCE, ITALY, OCTOBER 1-3, 2006

Background: Gastro-jejunal anastomotic leak is one of the most serious, life-threatening early complications of laparoscopic gastric bypass (Lap-GBP), ranging 2-20%, while internal hernia represents the most common cause of reintervention. Preliminary results hypothesized the efficacy and safety of the use of fibrin glue (Tissucol®, Baxter AG, Vienna) in Lap-GBP.We evaluated the use of fibrin glue in the prevention of these complications. Methods: The trial was conducted Jan 2004-Dec 2005. Patients with BMI 40-59 kg/m2, both genders, aged 21-60 years, undergoing Lap-GBP, were randomized in: fibrin glue group (Tissucol® applied on the gastro-jejunal and jejuno-jejunal anastomosis and over the mesenteric openings) and control group (no fibrin glue; suture of the mesenteric opening). Sex, age, BMI, operative time, oral diet initiation, hospital stay, reinterventions, early (<30 days) and late complications rates were evaluated. Results: 322 patients were randomized: 161 in the control group (mean age 39.8±11.3 years, mean BMI 46.9±7.6 kg/m2) and 161 in the fibrin glue group (mean age 41.6±10.9, mean BMI 47.2±6.5). Mortality and conversion were nil and no differences for operative time, oral diet initiation and hospital stay were recorded. No internal hernias were registered in Tissucol® group; 2 internal hernias determined 2 reinterventions in the control group. The incidence of leaks and the reoperation rate for this complication were higher in the control group, without reaching significant statistical difference. The overall reintervention rate for leak, internal hernia and bleeding was higher in the control group (P=0.01). Conclusion: Fibrin glue is safe, does not increase operative time, seems to be advantageous in reducing leaks and possibly in the closure of mesenteric defects after LRYGBP.