A 30 mm sized gastrojejunostomy may lead to a lower rate of therapy failure in comparison to a 45 mm sized gastrojejunostomy following laparoscopic Roux-en-Y gastric bypass

Abstract

Background: In bariatric surgery the laparoscopic Roux-en-Y gastric bypass (LRYGB) has been proven to be a safe and effective approach. Currently the optimal size of the linear-stapled gastrojejunostomy (GJ) and its impact on weight loss are not known due to a lack of clinical trials on that topic. We aimed to provide evidence on the impact of the GJ size in terms of gastric bypass weight loss.

Methods: Patients who underwent LRYGB due to morbid obesity were retrospectively analyzed from January 2013 to January 2016. While the procedure was completely standardized, one surgeon continued using the 45 mm sized linear stapler to perform GJ while the other switched to using a 30 mm cartridge.

Results: 277 patients were female (78%) and 77 males. The average age was 41.7 ± 12.3 years. In 118 cases a 30 mm sized GJ was conducted. 236 individuals received a 45 mm sized GJ. In terms of gender, age, length of biliary and alimentary limb both groups were homogenous. Individuals with a 30 mm sized GJ had a statistical significant lower rate of therapy failure (Excess weight loss <25%, 25-49%, ≥50% after 3 years, P value χ² for trend <0.035).The excess weight loss did not significant differ between both groups.

Conclusions: A 30 mm sized GJ may lead to a lower rate of therapy failure in comparison to a 45 mm sized GJ following laparoscopic Roux-en-Y gastric bypass. Prospective trials are mandatory to confirm our findings.

Keywords: Bariatric surgery; Gastric bypass; Gastroenterostomy; Gastrojejunostomy; Morbid obesity; Weight loss.

Fig. 1

Box plot of excess weight loss (%) after 1 (pale blue), 2 (blue), and 3 (dark blue) years in both study groups. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)