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Linear vs. circular-stapled gastrojejunostomy in Roux-en-Y gastric bypass

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Abstract

Background

Various surgical techniques exist to create the gastrojejunostomy during laparoscopic Roux-en-Y gastric bypass (LRYGB). Linear-stapled anastomosis (LSA) and circular-stapled anastomosis (CSA) are two commonly employed techniques. We hypothesized that CSA is associated with an increased rate of surgical site infection (SSI) and gastrojejunostomy stenosis when compared to LSA.

Methods

This study is a retrospective review of patients who underwent LRYGB for morbid obesity at a single institution between 2012 and 2016. Three bariatric surgeons contributed patients to this series. Clinical information and perioperative outcomes were collected through 90 days after surgery.

Results

171 patients met the inclusion criteria. Two patients did not complete 90-day follow-up and were excluded from the analysis (88 patients CSA, 81 LSA; 99% 90-day follow-up). Patient demographics did not differ between groups. The LSA technique was associated with a significantly reduced rate of SSI (0 (0%) vs. 6 (6.8%), p = 0.02) and stenosis (2 (2.5%) vs. 17 (19.3%), p < 0.01). The CSA technique demonstrated a greater number of endoscopic dilations per stenotic event (1.5 ± 0.8 vs. 1.0 ± 0, p = 0.03).

Conclusion

In our experience, a gastrojejunostomy constructed with an LSA technique was associated with a significantly reduced rate of stenosis and SSI compared to the CSA technique. LSA is currently our anastomotic technique of choice in LRYGB.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, HUB, 6th floor, Milwaukee, WI, 53226, USA

    Alexander C. Barr, Kathleen L. Lak, Melissa C. Helm, Tammy L. Kindel, Rana M. Higgins & Jon C. Gould

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  1. Alexander C. Barr
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  2. Kathleen L. Lak
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  3. Melissa C. Helm
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  4. Tammy L. Kindel
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  5. Rana M. Higgins
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  6. Jon C. Gould
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Correspondence to Jon C. Gould.

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Disclosures

Dr. Gould is a consultant for Torax Medical/Ethicon. Alexander C. Barr, Kathleen L. Lak, Melissa C. Helm, Tammy L. Kindel, Rana M. Higgins and Jon C. Gouldhave no financial conflicts to declare.

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Barr, A.C., Lak, K.L., Helm, M.C. et al. Linear vs. circular-stapled gastrojejunostomy in Roux-en-Y gastric bypass. Surg Endosc 33, 4098–4101 (2019). https://doi.org/10.1007/s00464-019-06712-2

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  • DOI: https://doi.org/10.1007/s00464-019-06712-2

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