Knotless tissue control devices for hand-sewn gastrojejunostomy in robotic-assisted Roux-en-Y gastric bypass

BACKGROUND: Literature on clinical and economic outcomes with hand-sewn gastrojejunostomy using Spiral Antibacterial Knotless Tissue Control Devices (KTCD) in Roux-en-Y gastric bypass (RYGB) is scant. OBJECTIVES: Assess clinical and economic outcomes of patients receiving KTCD for hand-sewn gastrojejunostomy vs. alternative means of anastomosis in robotic-assisted RYGB. SETTING: US hospital. METHODS: Patients who received gastrojejunostomy using KTCD in robotic-assisted RYGB between 01/01/2020-08/31/2023 identified in the Premier Healthcare Database (PHD) were evaluated via medical chart review (RYGB=index). Patients with alternative means of anastomosis, including non-KTCD sutures/staplers, in robotic-assisted RYGB in the PHD during the same timeframe were utilized as controls. Optimization-based stable balance weighting balanced the cohorts on baseline characteristics. Outcomes included a composite complication measure (anastomotic leak, bleeding, dilation of small intestine, infection, pelvic abscess, ileus/bowel obstruction) evaluated at index, index through 30 days and 90 days, anastomotic leak through 90 days, length of stay (LOS), and index costs. RESULTS: 145 patients in two hospitals met KTCD selection criteria; 6,491 met control criteria. Incidences of complications at index, 30 days, and 90 days were lower for KTCD vs. controls (0.7% vs. 4.5%, 0.7% vs. 7.3%, 2.1% vs. 8.3%; all p<0.01). LOS was shorter for KTCD vs. controls (1.34 vs. 1.62 days; p=0.002). Anastomotic leaks (1.4% vs. 2.0%; p=0.143) and index costs ($17,042 vs. $16,431; p=0.494) did not differ between KTCD vs. controls. CONCLUSIONS: This retrospective analysis of gastrojejunostomy in robotic-assisted RYGB found fully hand-sewn gastrojejunostomy with KTCD was associated with lower complication rates and shorter LOS vs. alternative means of anastomosis.