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Comparative Study
. 2015 Nov-Dec;11(6):1233-6.
doi: 10.1016/j.soard.2015.03.010. Epub 2015 Apr 2.

Comparison between circular- and linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass--a cohort from the Scandinavian Obesity Registry

David Edholm  1 , Magnus Sundbom  2
Affiliations
Comparative Study

Comparison between circular- and linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass--a cohort from the Scandinavian Obesity Registry

David Edholm et al. Surg Obes Relat Dis. 2015 Nov-Dec.

Abstract

Background: Although laparoscopic Roux-en-Y gastric bypass (LRYGB) is a common bariatric procedure worldwide, no consensus on the optimal technique for the gastrojejunostomy (GJ) has been reached. Circular stapling (CS) immediately results in a GJ of standardized width, whereas linear stapling (LS) requires a technically challenging closure of the stapler defect. The aim was to study differences in outcomes between CS and LS.

Setting: Nationwide Swedish cohort.

Methods: The Scandinavian Obesity Registry (SOReg) included prospective data from 34,284 primary LRYGB patients operated on in 2007-2013. We studied operative time, length of hospital stay, postoperative complications, and percent excess body mass index loss (%EBMIL) after 1 year. Outcomes were assessed through multivariate analysis adjusting for gender, age, preoperative body mass index (BMI), and diabetes.

Results: Preoperatively the groups were similar (40.9 yr, BMI 42.4 kg/m(2), 76% female). For CS and LS, operative time and hospital stay were 114 and 73 minutes (P<.001) and 4.6 and 2.0 days (P<.001), respectively. Using LS as a reference, adjusted odds ratio (OR) for CS patients to have anastomotic leakage was 2.8 (95% CI 1.5-5.0), postoperative hemorrhage 1.9 (95% CI 1.2-2.9), wound complication 9.7 (95% CI 6.8-13.9), and marginal ulcer 3.1 (95% CI 1.8-5.3). The %EBMIL at 1 year was 80% for both techniques and 31% of total weight was lost. Follow-up rate at 6 weeks and 1 year was 96% and 73%, respectively.

Conclusion: CS was found to be associated with disadvantages regarding operative time, hospital stay, and postoperative complications compared with LS.

Keywords: Circular stapler; Complications; Gastric bypass; Gastrojejunostomy; Laparoscopic gastric bypass; Morbid obesity; Stapling technique.

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