Outcomes of linear-stapled versus hand-sewn gastrojejunal anastomosis in laparoscopic Roux en-Y gastric bypass

Abstract

Background: In laparoscopic Roux en-Y gastric bypass (LRYGB), the gastrojejunal anastomosis (GJA) may be performed using linear-stapled (LS) or completely hand-sewn (HS) techniques. No published study has compared operative and clinical outcomes following LS and HS LRYGB when performed by surgeons beyond the learning curve. This study examined outcomes of both techniques performed by two 'technique-specific' bariatric fellowship-trained surgeons.

Methods: Data on consecutive primary LRYGB undertaken in two university hospitals were prospectively collected over 28-months and included demographics, co-morbidities, postoperative morbidity, mortality, length of stay (LOS), reoperations, and excess weight loss (EWL). Data were presented as mean ± SD.

Results: There were 366 LRYGB studied (LS = 144 and HS = 222 patients) with 96 % 12-month follow-up. All procedures were completed laparoscopically with no anastomotic leak or mortality. The LS cohort had a lower body mass index (48.3 ± 5.0 vs 53.8 ± 7.1, P < 0.001), greater incidence of diabetes mellitus (P = 0.009) and sleep apnea (P = 0.007). The HS cohort had more patients in Obesity Surgery Mortality Risk Score classes B and C (P = 0.004 and P = 0.01), and shorter operating time (127 ± 30 vs 172 ± 30 min, P < 0.001). There were no differences in LOS, complications, or reoperations. The HS technique was associated with more GJA stenoses requiring endoscopic dilatation (7.7 vs 0 %, P < 0.001). At 12 months, EWL (%) was comparable between the two techniques (LS 71.0 ± 15.5 vs HS 66.5 ± 13.7, P = 0.09).

Conclusions: When performed by 'technique-specific' surgeons, both LS and HS GJA in LRYGB may be performed safely with no significant differences in morbidity, reoperations, or EWL.