Effect of staple height on gastrojejunostomy during laparoscopic gastric bypass: a multicenter prospective randomized trial

Abstract

Background Gastrointestinal (GI) bleeding and anastomotic stricture are frequent complications associated with the construction of the gastrojejunostomy during laparoscopic gastric bypass. Staplers with shorter staple height can reduce the rate of postoperative GI hemorrhage. The aim of the present study was to assess the outcomes of patients who had undergone gastric bypass with construction of the gastrojejunostomy using a 25-mm circular stapler with a 3.5- versus 4.8-mm staple height. Methods From January 2007 to February 2009, 357 patients underwent laparoscopic gastric bypass using a circular stapler for construction of the gastrojejunostomy were randomly assigned to either the 3.5-mm (n = 180) or 4.8-mm (n = 177) group. Two patients randomized to the 4.8-mm group did not undergo the operative procedure and were excluded from the analysis. The primary outcome measures included the rate of GI hemorrhage, anastomotic stricture, and wound infection. Results The 2 groups were similar with regard to the demographics and baseline body mass index (47 versus 48 kg/m 2). The operative time, blood loss, and postoperative hematocrit on day 2 were similar between the 2 groups. No significant differences were seen in the overall rate of intraoperative GI bleeding or postoperative GI bleeding from all sources (3.3% for 3.5 mm versus 6.3% for 4.8 mm, P >.05); however, a trend was seen toward a lower rate of postoperative GI bleeding from the gastric pouch or gastrojejunostomy (.5% for 3.5 mm versus 3.4% for 4.8 mm, P = .06). The rate of anastomotic stricture was significantly lower in the 3.5-mm group (3.9% versus 16.0%, P <.01). No significant differences were seen in rate of wound infection between the 2 groups. Other morbidities for the entire study cohort included leaks (1.1%), pulmonary embolism (.6%), gastrointestinal obstruction (1.4%), and reoperation (3.4%). The overall in-hospital mortality rate was .3%, and the 30-day mortality rate was .8%. Conclusions In the present prospective, randomized trial, using a circular stapler with a shorter staple height (3.5 mm) during construction of the gastrojejunostomy, significantly reduced the rate of postoperative anastomotic stricture, with a trend toward a lower rate of GI bleeding from the gastrojejunostomy.