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. 2021 Jan;31(1):267-273.
doi: 10.1007/s11695-020-04932-3. Epub 2020 Aug 26.

Gastrojejunal Anastomotic Technique. Does It Matter? Weight Loss and Weight Regain 5 Years After Laparoscopic Roux-en-Y Gastric Bypass

Matyas Fehervari  1   2 , Khaled Alyaqout  3   4 , Ali Lairy  3   5 , Haris Khwaja  3   6 , Gianluca Bonanomi  3   6 , Evangelos Efthimiou  3   6
Affiliations

Gastrojejunal Anastomotic Technique. Does It Matter? Weight Loss and Weight Regain 5 Years After Laparoscopic Roux-en-Y Gastric Bypass

Matyas Fehervari et al. Obes Surg. 2021 Jan.

Abstract

Purpose: The gastrojejunostomy during laparoscopic Roux-en-Y gastric bypass (LRYGB) can be constructed by hand sewn (HSA), linear (LSA) and circular (CSA) stapler technique. They are all considered safe; however, it is not known which the best technique is. Short-term follow-up suggest no difference in weight loss or weight regain between them. However, there is no information on these parameters in the long term. Theatre time and cost are other important factors defining the best way to form gastrojejunostomy.

Materials and methods: In a prospective longitudinal cohort study consecutive patients following primary LRYGB were recruited to a bariatric database in a tertiary care centre. Anastomotic technique, diameter, the length of operations and associated costs, weight loss and weight regain were recorded. Patients were followed up for 5 years.

Results: A total of 385 patients with an initial body mass index of 47.1 kg/m2 (35-68) were enrolled to this study. This decreased to 33.3 kg/m2 (21-54 kg/m2) after 5 years. There was no difference in %TWL after 3 years, P = 0.296, or 5 years, P = 0.187, between the techniques. The number of patients with weight regain was not different after 3 years, P = 0.224, or 5 years, P = 0.795. All techniques had similar operative time. CSA has a higher material cost. Early anastomotic stricture was more common following HSA; however, the difference was not significant.

Conclusion: Mid-term weight loss and weight regain are not related to anastomotic technique, and there is no difference in operative time associated to them. Circular stapler technique has a higher material cost due to the additional stapler.

Keywords: Anastomosis size; Anastomotic technique; Gastric bypass; Gastrojejunal anastomosis; Gastrojejunal stoma size; LRYGB; Laparoscopic roux-en-Y gastric bypass; Surgical technique; Weight loss; Weight regain.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Scatterplot diagram of percentage total and excess weight loss 1 year after surgery. Kruskal–Wallis one-way ANOVA, values are mean ± standard error of mean
Fig. 2
Fig. 2
Scatterplot diagram of percentage total and excess weight loss 3 years after surgery. Kruskal–Wallis one-way ANOVA, values are mean ± standard error of mean
Fig. 3
Fig. 3
Scatterplot diagram of percentage total and excess weight loss 5 years after surgery. Kruskal–Wallis one-way ANOVA, values are mean ± standard error of mean
See this image and copyright information in PMC

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