Linear versus Circular Stapler for Gastrojejunal Anastomosis in Laparoscopic Roux-En-Y Gastric Bypass: An Analysis of 211 Cases

Abstract

Purpose: Although laparoscopic Roux-en-Y gastric bypass (LRYGB) is a frequently performed bariatric procedure, there is still no consensus on its technical implementation.

Methods: 211 patients treated with LRYGB in a single institution between March 2011 and October 2016 were analyzed retrospectively. A subgroup analysis for the linear (LSA) versus circular stapler technique (CSA) for gastrojejunal anastomosis (GJA) was performed to evaluate complications and outcomes.

Results: 128 (60.6%) patients received GJA with CSA and 83 (39.4%) with LSA. Average weight loss one year after surgery, respectively, BMI after one year of follow-up (kg/m²), showed no significant difference. Median surgery time was significantly shorter in the LSA group. If the procedure was performed with CSA, significantly more wound infections occurred.

Conclusions: Both the circular and the linear stapler techniques for gastrojejunal anastomosis in laparoscopic Roux-en-Y gastric bypass are safe methods with comparable outcomes. A disadvantage of CSA is the significantly higher rate of wound infections, a circumstance which requires increased attention.

Figure 1

Circular and linear stapler techniques for gastrojejunal anastomosis. (a) Roux-en-Y gastric bypass. CSA technique: (b) inserting the stapler head in the stomach before gastric pouch formation; (c) forming the gastric pouch and leading out the central rod from the pouch, inserting the circular stapler into the jejunal loop, and performing anastomosis. LSA technique: (d) after forming the stomach pouch, the jejunal loop is brought near and fixed with a holding thread, opening of the stomach pouch and the jejunal loop and introduction of the linear stacker, and preparation of the anastomosis; (e) closure of the opening for the stacker. GJA: gastrojejunal anastomosis, p: stomach pouch, s: residual stomach, b: biliary limb, a: alimentary limb, jj: jejunojejunostomy, and cc: common channel (the anastomosis was shown here once in front of and once behind the stapler suture row of the stomach pouch for simpler illustration).