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Comparative Study
. 2025 Jun;35(6):2132-2141.
doi: 10.1007/s11695-025-07875-9. Epub 2025 Apr 26.

Long-Term Results of Linear Versus Circular Stapled Gastrojejunostomy in Gastric Bypass Surgery: A Propensity Score-Adjusted Analysis of Weight Loss and Morbidity

Mathias Schmid  1 , Patrick Folie  2 , Rene Warschkow  2 , Thomas Steffen  2
Affiliations
Comparative Study

Long-Term Results of Linear Versus Circular Stapled Gastrojejunostomy in Gastric Bypass Surgery: A Propensity Score-Adjusted Analysis of Weight Loss and Morbidity

Mathias Schmid et al. Obes Surg. 2025 Jun.

Abstract

Background: Different techniques are used to create a gastrojejunal anastomosis (GJ) in laparoscopic Roux-en-Y gastric bypass (LRYGB). This study compares long-term weight loss and technique-related morbidity between circular (CSA) GJ and linear (LSA) stapled GJ.

Methods: The clinical data of LRYGB patients prospectively registered in a database were retrospectively analyzed. The primary endpoints were long-term excess weight loss (EWL) and excess BMI loss (EBL). The risk factors were adjusted via propensity score matching (PSM), and the long-term morbidity rates of the procedures were compared as time-to-event-data using hazard ratios (HR).

Results: Two hundred forty-three patients underwent surgery between 2012 and 2014 (CSA n = 109; LSA n = 134). No significant differences in weight development were shown during 6 years postoperatively between CSA and LSA. A mixed effects regression analysis before and after PSM revealed that CSA performed better than LSA after 6 years (potentially biased by low follow-up rates for this period). CSA was associated with higher overall morbidity (LSA 26.1% vs. CSA 38.8%, HR = 1.58, p = 0.048), incisional hernia (LSA 0.7% vs. CSA 6.4%, HR = 10.0, p = 0.006), and GJ stenosis rates (LSA 0% vs. CSA 17.4%, p < 0.001). LSA was associated with marginal ulcers (LSA 8.2% vs. CSA 0.9%, HR = 5.5, p = 0.012).

Conclusions: Marginal ulcers have been linked to LSA, while CSA has been associated with higher rates of overall morbidity, stenosis of the GJ, and incisional hernia. No difference terms of weight loss were observed between the CSA and LSA groups during the initial six postoperative years. After 6 years, CSA may offer benefits in terms of sustained weight loss; however, the clinical relevance of these differences appears minimal.

Keywords: Gastric bypass; Incisional hernia; Marginal ulcer; Roux-en-Y; Weight loss.

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Conflict of interest statement

Declarations. Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent: Informed consent was obtained from all individual participants included in the study. Competing interests: The authors declare no competing interests.

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