Linear versus Circular Stapler for Gastrojejunal Anastomosis in Laparoscopic Roux-En-Y Gastric Bypass: An Analysis of 211 Cases

Abstract

Purpose. Although laparoscopic Roux-en-Y gastric bypass (LRYGB) is a frequently performed bariatric procedure, there is still no consensus on its technical implementation. Methods. 211 patients treated with LRYGB in a single institution between March 2011 and October 2016 were analyzed retrospectively. A subgroup analysis for the linear (LSA) versus circular stapler technique (CSA) for gastrojejunal anastomosis (GJA) was performed to evaluate complications and outcomes. Results. 128 (60.6%) patients received GJA with CSA and 83 (39.4%) with LSA. Average weight loss one year after surgery, respectively, BMI after one year of follow-up (kg/m2), showed no significant difference. Median surgery time was significantly shorter in the LSA group. If the procedure was performed with CSA, significantly more wound infections occurred. Conclusions. Both the circular and the linear stapler techniques for gastrojejunal anastomosis in laparoscopic Roux-en-Y gastric bypass are safe methods with comparable outcomes. A disadvantage of CSA is the significantly higher rate of wound infections, a circumstance which requires increased attention.

Linear Versus Circular Laparoscopic Gastrojejunal Anastomosis of Roux-en-Y Gastric Bypass: Systematic Review and Meta-Analysis of 22 Comparative Studies

“…The Prisma flow chart for the study selection is shown in Figure 1. Twenty-one articles12–33 on bariatric surgery were included in one or more of the outcome analyses (7 prospective cohorts and 14 retrospective cohorts; Table 1). In total, 51,672 patients were included, of which 41,358 underwent surgery with LSA and 10,314 with CSA; The sample size of these studies ranged from 61 to 34.284 patients.…”

Mechanical Stapling Devices for Soft Tissue Repair: A Review of Commercially Available Linear, Linear Cutting, and Circular Staplers

“…Specialists use them for end-to-side, end-to-end, and side-to-side anastomoses. The applications of circular staplers involve the anastomosis of the proximal colon with the distal colon during colostomy, laparoscopic distal gastrectomy, and gastrojejunal anastomosis in Roux-en-Y gastric bypass [67][68][69][70][71][72][73]. Circular staplers also play an increasingly important role in vascular anastomoses [74].…”

“…Gastrojejunostomy is one of the most analyzed techniques for anastomosis. Typically, two different types of staplers' outcomes are compared, and the authors consider linear and circular staplers' techniques for the outcome comparison [3,[68][69][70][71][72][73]76].…”

Impact of Short-Term Weight Loss on Hemostasis and Thrombosis after Bariatric Surgery

“…With bariatric surgery, long-term permanent weight loss can be achieved, and many comorbidities are prevented by ameliorating the metabolic efects of obesity, thereby increasing the survival. Sustainable weight loss can be achieved with the highest rate of bariatric surgery, and more than 50% of excess weight can be lost [15]. Individuals who will undergo bariatric surgery are considered risky patients.…”