Reduction of surgical site infections after laparoscopic gastric bypass with circular stapled gastrojejunostomy

Abstract Background Circular stapled gastrojejunostomy (GJ) is favored by many surgeons during laparoscopic Roux-en-Y gastric bypass (LRYGB). However, it has been associated with higher rates of surgical site infection (SSI). Objectives To study the impact of introducing standard technical modifications (intervention) on the incidence of SSI after LRYGB with circular stapled GJ. Setting Tertiary academic medical center. Methods Consecutive patients who underwent primary LRYGB between May 2010 and September 2014 were separated into preintervention and postintervention cohorts. The intervention consisted of the use of a stapler cover, wound irrigation, antibiotic application to the wound, and primary wound closure. Predictor variables studied included patient demographic characteristics, the intervention, and other operative and perioperative factors. The primary outcome studied was SSI. Univariate and multivariate analyses were used to determine factors independently associated with SSI. Results Three hundred thirty patients underwent LRYGB (preintervention n = 200, postintervention n = 130). Patients’ characteristics were similar in both groups. A 21-mm stapler and chlorhexidine-based skin preparation were more frequently used in the postintervention group. SSI rate decreased from 15% to 3.8% ( P