Complications at gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass: comparison between 21- and 25-mm circular staplers

Abstract

Background: Complications involving the gastrojejunostomy (GJ) after laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity frequently result in hospital readmission and additional procedures. The purpose of this study was to compare the complication rate of GJ performed with the 21- and 25-mm circular staplers.

Methods: We retrospectively reviewed the incidence of stricture, bleeding, ulcer, and leak at the GJ in 438 consecutive patients who had undergone LRYGB.

Results: The GJ was performed using the 25-mm stapler in 374 patients and the 21-mm stapler in 64 patients. Of the 50 anastomotic complications, 11 (17.2%) occurred with the 21-mm stapler, including 6 strictures (9.4%), 4 ulcers (6.3%), and 1 leak (1.6%), and 39 (10.4%) with the 25-mm stapler, including 11 strictures (2.9%), 6 acute bleeding episodes (1.6%), 19 ulcers (5.4%), and 4 leaks (1.1%). Rehospitalization was required in 9 patients (47%) with a pure stricture and 17 (74%) with ulcers. The incidence of pure stricture was significantly greater in the GJ performed with the 21-mm than with the 25-mm stapler (P = .026, Fisher's exact test). No difference was found in the rate of acute bleeding, leak, or ulcer between the 2 groups. All strictures resolved with balloon dilation. Four patients with stenotic ulcers that failed to respond to dilation and medications required operative revision. No difference was found in postoperative weight loss between the 2 groups.

Conclusion: Anastomotic complications were recognized in 50 (11.4%) of 438 patients who had undergone LRYGB in which the GJ was performed using circular staplers, including 11 (17.2%) with the 21-mm and 39 (10.2%) with the 25-mm stapler. The rate of anastomotic stricture was significantly lower using the 25-mm circular stapler.