Linear-stapled Versus Circular-stapled Laparoscopic Gastrojejunal Anastomosis in Morbid Obesity

Abstract

This pooled analysis recommends the preferential use of the linear stapling technique over circular stapling.

Comparison of circular- and linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass: a multicenter study.

“…The risk of infectious wound complications was significantly higher in the studies by Penna et al [10] (pooled OR = 3.13; 95% CI: 2.27–4.35) and Edholm and Sundbom [3] (OR = 9.7; 95% CI: 6.8–13.9). We also revealed that the risk of wound infection increased with the use of a circular stapler.…”

“…In the present study, the use of a circular stapler significantly increased the risk of postoperative hemorrhage, which has also been commonly reported in other studies. In a meta-analysis of five studies by Penna et al [10], the use of a circular stapler was associated with a 117% greater risk of postoperative bleeding in the pooled analysis (pooled odds ratio (OR) = 2.17; 95% confidence interval (CI): 1.49–3.23). An increased risk of postoperative bleeding was also reported in a more recent study by Edholm and Sundbom [3] (OR = 1.9; 95% CI: 1.2–2.9).…”

“…Hand sewing is now infrequently performed because it is technically demanding and not reproducible. Circular- and linear-stapled GJ are widely accepted as faster and reproducible methods [7–10]. The two methods have been compared in numerous studies, but no consensus regarding which method is superior has yet been reached [3, 7–11].…”

Stapling Versus Hand Suture for Gastroenteric Anastomosis in Roux-en-Y Gastric Bypass: a Randomized Clinical Trial

“…As in our study, the articles published on HSA by Ahmed [11] and Ruiz de Adana [2] report a GIB incidence of 0.4 %. However, mechanical anastomosis presents a rate of GIB ranging from 1.7 to 8.1 % [9,12]. A meta-analysis on more than 9000 patients shows greater postoperative GIB for CSA than for LSA (p<0.0001).…”

“…In our study, there was only one case of anastomotic leakage (0.86 %), in the HSA group, which was resolved with suture of the dehiscence and placement of drainage. The meta-analysis published by Penna et al [12] shows no differences in the incidence of leakage between CSA and LSA. The incidence of anastomotic leakage in the study published by Kravetz et al [15] is 0.9 % (with no significant differences between HSA and CSA).…”