Linear compared to circular stapler anastomosis in laparoscopic Roux-en-Y gastric bypass leads to comparable weight loss with fewer complications: a matched pair study

Schneider, Romano; Gass, Jörn‐Markus; Kern, Beatrice; Peters, Thomas; Slawik, Marc; Gebhart, Martina; Peterli, Ralph

doi:10.1007/s00423-016-1397-0

Cited by 23 publications

(12 citation statements)

References 24 publications

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“…However, no studies have evaluated QoL following totally laparoscopic surgery. Schneider et al[ 36 ] reported that the diameter of the anastomotic stoma obtained using the linear stapler was significantly larger than that achieved with the circular stapler, which benefits the passage of food. At 6 mo post-surgery, we found that symptoms of dysphagia were better in group T, especially in terms of eating solid food.…”

Section: Discussionmentioning

confidence: 99%

Digestive tract reconstruction using isoperistaltic jejunum-later-cut overlap method after totally laparoscopic total gastrectomy for gastric cancer: Short-term outcomes and impact on quality of life

Huang¹,

Huang²,

Zheng³

et al. 2017

WJG

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AIMTo evaluate the short-term outcomes and quality of life (QoL) in gastric cancer patients undergoing digestive tract construction using the isoperistaltic jejunum-later-cut overlap method (IJOM) after totally laparoscopic total gastrectomy (TLTG).METHODSA total of 507 patients who underwent laparoscopic gastrectomy (D2) from January 2014 to March 2016 were originally included in the study. The patients were divided into two groups to undergo digestive tract construction using either IJOM after TLTG (group T, n = 51) or Roux-en-Y anastomosis after laparoscopic-assisted total gastrectomy (LATG) (group A, n = 456). The short-term outcomes and QoL were compared between the two groups after 1:2 propensity-score matching (PSM). We used a questionnaire to assess QoL.RESULTSBefore matching, age, sex, tumor size, tumor location, preoperative albumin and blood loss were significantly different between the two groups (P < 0.05). After PSM, the patients were well balanced in terms of their clinicopathological characteristics, although both blood loss and in-hospital postoperative days in group T were significantly lower than those in group A (P < 0.05). After matching, group T reported better QoL in the domains of pain and dysphagia. Among the items evaluating pain and dysphagia, group T tended to report better QoL (“Have you felt pain” and “Have you had difficulty eating solid food”) (P < 0.05).CONCLUSIONThe IJOM for digestive tract reconstruction after TLTG is associated with reduced blood loss and less pain and dysphagia, thus improving QoL after laparoscopic gastrectomy.

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Section: Discussionmentioning

confidence: 99%

Digestive tract reconstruction using isoperistaltic jejunum-later-cut overlap method after totally laparoscopic total gastrectomy for gastric cancer: Short-term outcomes and impact on quality of life

Huang¹,

Huang²,

Zheng³

et al. 2017

WJG

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“…Finally, circular staplers may be used to create the gastrojejunostomy anastomosis as an alternative to the staplers of interest under study, which introduces potential for use of another device in an important step of the LRY. There are presently mixed data on whether circular staplers increase the risk of complications in in LRY 24,25 ; however, if this technique correlates with use of powered vs manual staplers, it is possible that it could be a confounding factor for a number of the study outcomes-particularly costs arising from use of a second device. Thus, another sensitivity analysis was performed in which circular stapler use was included as a covariate in the multivariable models for the sub-group of patients undergoing LRY.…”

Section: Sub-group and Sensitivity Analysesmentioning

confidence: 99%

Comparison of economic and clinical outcomes between patients undergoing laparoscopic bariatric surgery with powered versus manual endoscopic surgical staplers

Roy¹,

Yoo

Yadalam

et al. 2017

Journal of Medical Economics

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Aims: To compare economic and clinical outcomes between patients undergoing laparoscopic Rouxen-Y gastric bypass (LRY) or laparoscopic sleeve gastrectomy (LSG) with use of powered vs manual endoscopic surgical staplers. Materials and methods: Patients (aged !21 years) who underwent LRY or LSG during a hospital admission (January 1, 2012-September 30, 2015 were identified from the Premier Perspective Hospital Database. Use of powered vs manual staplers was identified from hospital administrative billing records. Multivariable analyses were used to compare the following outcomes between the powered and manual stapler groups, adjusting for patient and hospital characteristics and hospital-level clustering: hospital length of stay (LOS), total hospital costs, medical/surgical supply costs, room and board costs, operating room costs, operating room time, discharge status, bleeding/transfusion during the hospital admission, and 30, 60, and 90-day all-cause readmissions. Results: The powered and manual stapler groups comprised 9,851 patients (mean age ¼ 44.6 years; 79.3% female) and 21,558 patients (mean age ¼ 45.0 years; 78.0% female), respectively. In the multivariable analyses, adjusted mean hospital LOS was 2.1 days for both the powered and manual stapler groups (p ¼ .981). Adjusted mean total hospital costs ($12,415 vs $13,547, p ¼ .003), adjusted mean supply costs ($4,629 vs $5,217, p ¼ .011), and adjusted mean operating room costs ($4,126 vs $4,413, p ¼ .009) were significantly lower in the powered vs manual stapler group. The adjusted rate of bleeding and/or transfusion during the hospital admission (2.46% vs 3.22%, p ¼ .025) was significantly lower in the powered vs manual stapler group. The adjusted rates of 30, 60, and 90-day all-cause readmissions were similar between the groups (all p > .05). Sub-analysis by manufacturer showed similar results. Limitations: This observational study cannot establish causal linkages. Conclusions: In this analysis of patients who underwent LRY or LSG, the use of powered staplers was associated with better economic outcomes, and a lower rate of bleeding/transfusion vs manual staplers in the real-world setting.ARTICLE HISTORY

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“…In 2009, we changed from the circular to the linear stapling LRYGB technique. Our technique has been described in detail previously [20]. In brief, the GE between the gastric pouch and the alimentary limb is created by two-thirds of the length of a 45-mm linear stapler magazine.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…In the original version of the linear stapled LRYGB technique described by Hans Lönroth, the mesenteric defects were not closed, but the omentum was routinely split in the vertical direction to facilitate a tension free anastomosis between AL and the pouch [7]. As a consequence of the evidence provided by Aghajani et al and Stenberg et al, in 2016, we started closing mesenteric defects as part of our antecolic linear LRYGB technique [13,17,20]. However, though the rate of Petersen hernias was low in our previously published results, the new closure technique could cause obstruction of the transverse colon or bleeding at the transverse mesocolon.…”

Section: Introductionmentioning

confidence: 99%

Does the non-absorbable suture closure of the jejunal mesenteric defect reduce the incidence and severity of internal hernias after laparoscopic Roux-en-Y gastric bypass?

Schneider

Schulenburg

Kraljević

et al. 2021

Langenbecks Arch Surg

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Purpose Internal hernias (IH) are frequent complications after laparoscopic Roux-en-Y gastric bypass (LRYGB). Closure of the jejunal mesenteric and the Petersen defect reduces IH incidence in prospective and retrospective trials. This study investigates whether closing the jejunal mesenteric space alone by non-absorbable suture and splitting the omentum can be beneficial to prevent IH after LRYGB. Methods Observational cohort study of 785 patients undergoing linear LRYGB including omental split at a single institution, with 493 patients without jejunal mesenteric defect closure and 292 patients with closure by non-absorbable suture, and a minimal follow-up of 2 years. Patients were assessed for appearance and severity of IH. Additionally, open mesenteric gaps without herniated bowel as well as early obstructions due to kinking of the entero-enterostomy (EE) were explored. Results Through primary mesenteric defect closure, the rate of manifest jejunal mesenteric and Petersen IH could be reduced from 6.5 to 3.8%, but without reaching statistical significance. The most common location for an IH was the jejunal mesenteric space, where defect closure during primary surgery reduced the rate of IH from 5.3 to 2.4%. Higher weight loss seemed to increase the risk of developing an IH. Conclusion The closure of the jejunal mesenteric defect by non-absorbable suture may reduce the rate of IH at the jejunal mesenteric space after LRYGB. However, the beneficial effect in our collective is smaller than expected, particularly in patients with good weight loss. The Petersen IH rate remained low by consequent T-shape split of the omentum without suturing of the defect.

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Linear compared to circular stapler anastomosis in laparoscopic Roux-en-Y gastric bypass leads to comparable weight loss with fewer complications: a matched pair study

Abstract: Linear stapler anastomosis in LRYGB compared to circular anastomosis leads to equal weight loss and less strictures. The lower rate of internal hernias in linear stapler anastomosis was not significantly different.

Cited by 23 publications

References 24 publications

Digestive tract reconstruction using isoperistaltic jejunum-later-cut overlap method after totally laparoscopic total gastrectomy for gastric cancer: Short-term outcomes and impact on quality of life

Digestive tract reconstruction using isoperistaltic jejunum-later-cut overlap method after totally laparoscopic total gastrectomy for gastric cancer: Short-term outcomes and impact on quality of life

Comparison of economic and clinical outcomes between patients undergoing laparoscopic bariatric surgery with powered versus manual endoscopic surgical staplers

Does the non-absorbable suture closure of the jejunal mesenteric defect reduce the incidence and severity of internal hernias after laparoscopic Roux-en-Y gastric bypass?

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