Abstract
PurposeThe gastrojejunostomy during laparoscopic Roux-en-Y gastric bypass (LRYGB) can be constructed by hand sewn (HSA), linear (LSA) and circular (CSA) stapler technique. They are all considered safe; however, it is not known which the best technique is. Short-term follow-up suggest no difference in weight loss or weight regain between them. However, there is no information on these parameters in the long term. Theatre time and cost are other important factors defining the best way to form gastrojejunostomy.Materials and MethodsIn a prospective longitudinal cohort study consecutive patients following primary LRYGB were recruited to a bariatric database in a tertiary care centre. Anastomotic technique, diameter, the length of operations and associated costs, weight loss and weight regain were recorded. Patients were followed up for 5 years.ResultsA total of 385 patients with an initial body mass index of 47.1 kg/m2 (35–68) were enrolled to this study. This decreased to 33.3 kg/m2 (21–54 kg/m2) after 5 years. There was no difference in %TWL after 3 years, P = 0.296, or 5 years, P = 0.187, between the techniques. The number of patients with weight regain was not different after 3 years, P = 0.224, or 5 years, P = 0.795. All techniques had similar operative time. CSA has a higher material cost. Early anastomotic stricture was more common following HSA; however, the difference was not significant.ConclusionMid-term weight loss and weight regain are not related to anastomotic technique, and there is no difference in operative time associated to them. Circular stapler technique has a higher material cost due to the additional stapler.
Highlights
The gastrojejunostomy during laparoscopic Roux-en-Y gastric bypass (LRYGB) can be constructed by hand sewn (HSA), linear (LSA) and circular (CSA) stapler technique
Our results are similar to short-term results suggesting that midterm weight loss is equivalent between the three techniques
HSA was performed most frequently followed by linear stapler (LSA) and circular stapler (CSA) over the study period
Summary
The gastrojejunostomy during laparoscopic Roux-en-Y gastric bypass (LRYGB) can be constructed by hand sewn (HSA), linear (LSA) and circular (CSA) stapler technique They are all considered safe; it is not known which the best technique is. Conclusion Mid-term weight loss and weight regain are not related to anastomotic technique, and there is no difference in operative time associated to them. The three most common surgical techniques forming the gastrojejunostomy are hand-sewn (HSA), linear stapler (LSA) and circular stapler (CSA) anastomosis [12]. These techniques are often used based on a surgeon’s preference determined by their training and experience. There are even fewer studies investigating the three techniques simultaneously, with those suggesting no difference between them on the short term [18].There are no studies investigating weight loss in relation to all three gastrojejunostomy technique beyond 2 years
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