Anastomotic Stricture Rates Following Roux-en-Y Gastric Bypass for Morbid Obesity: A Comparison Between Linear and Circular-Stapled Anastomosis

Abstract

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective procedure in the management of morbid obesity with variations in outcome, which are technique dependent. Anastomotic stricture remains an important complication. The aim of this study was to assess the long-term outcome of patients undergoing either a linear-stapled anastomosis (LSA) or circular-stapled anastomosis (CSA) with an emphasis on postoperative stricture formation and excess body weight loss (EBWL).

Methods: Medical records of all patients who underwent bariatric surgery between 2008 and 2013 at a single bariatric surgical center were reviewed. All patients who had a LRYGB were included in the study. Patients were divided in two groups based on stapling technique-LSA and CSA. Patient groups were compared with regard to perioperative complication, EBWL.

Results: A total of 114 patients were included in the study. There were 51 patients in the LSA group and 63 in the CSA group. No differences were found between the two groups with regard to operative time, hospital stay, or in the EBWL over a 12-month follow-up period. Anastomotic stricture developed in 4 patients, all occurring in the LSA group (7.8%). Three of these patients had undergone successful endoscopic dilatation.

Conclusions: Both stapling techniques resulted in a similar EBWL during the follow-up period and an acceptable safety profile. Anastomotic stricture rate was slightly higher in the LSA, but this did not affect EBWL.

Keywords: anastomotic stricture; circular-stapled anastomosis; gastrojejunal stricture; laparoscopic Roux-en-Y gastric bypass; linear-stapled anastomosis; morbid obesity.