Hand-Sewn Gastrojejunal Anastomosis in Laparoscopic Roux-en-Y Gastric Bypass: A Comparison of Absorbable Monofilament Versus Non-Absorbable Multifilament Sutures and Their Impact on the Symptomatic Anastomotic Stricture Rate.

Introduction: Gastrojejunal anastomosis (GJA) stricture is an important complication after laparoscopic Roux-en-Y gastric bypass (LRYGB). The impact of suture material on stricture rate when performing a hand-sewn GJA is not well established. Methods: This is a retrospective analysis of a prospectively maintained database that includes 882 patients who underwent primary or revisional LRYGB with a minimum 12-month follow-up. We compared two consecutive groups of patients who underwent hand-sewn gastrojejunal anastomosis: group 1 (n = 426), utilizing a multifilament non-absorbable/absorbable suture combination (silk/Vicryl®), whereas group 2 (n = 456) received an absorbable monofilament suture (Monocryl®). The primary outcome was the incidence of symptomatic GJA stricture, defined as an inability to pass a 10 mm gastroscope associated with dysphagia, vomiting, or food intolerance. Results: The symptomatic stricture rate was significantly lower in group 2 (0.7% vs. 6.8%; p < 0.001). On multivariate analysis, the use of monofilament sutures was a stronger protective factor (OR 0.09; 95% CI 0.03-0.30; p < 0.001), whereas revisional surgery was associated with an increased risk of symptomatic stricture (OR 2.61; 95% CI 1.05-6.50; p = 0.03). Type 2 diabetes mellitus and gender were not independent predictors. One-year weight loss was similar between patients who developed symptomatic strictures (and required dilations) and those who did not (p > 0.05). Conclusion: The use of absorbable monofilament sutures for hand-sewn GJA in LRYGB reduces the risk of symptomatic stricture without compromising weight loss outcomes. These findings support a personalized suture strategy, especially in high-risk patients undergoing revisional surgery.