Abstract
BACKGROUND: The literature shows that stricture rates at gastrojejunal anastomosis (GJA) following laparoscopic gastric bypass (LGBP) vary from 1.6% to 40% for circular stapled (CSA) and 3% to 14.6% for linear stapled (LSA) GJA. The aim of this study was to evaluate whether circular stapled versus linear stapled GJA impacts stricture rates. METHODS: This was a prospective, concurrent cohort study. Patients underwent ante-colic, ante-gastric Roux-en-Y LGBP with either circular stapled GJA (25-mm circular stapler) or with linear stapled GJA (2 layers of running sutures). GJA stricture was defined by obstructive symptoms with a GJA requiring endoscopic balloon dilatation to allow passage of a 9.8 mm endoscope. Values were median (range). RESULTS: There were no deaths. There were 39 patients in the CSA and 39 patients in the LSA arms. Patients were well-matched for age 41 (23–55) vs. 44 (29–62) years, gender (35: 4 vs. 31: 8), American Society of Anesthesiology score (14: 20: 5 vs. 0: 38: 1), body mass index 46.2 (35–66.7) vs. 51.0 (37–73) and co-morbidities 4 (2–10) vs. 4 (1–7). There were no significant differences in estimated blood loss 50 (50–3000) vs. 50 (50–75) ml, length of stay 4 (3–48) vs. 4 (3–8) days, complications (7 vs. 3) and re-operations (2 vs. 2). Operating time 196 (140–370) vs. 90 (60–120) (p ≪ 0.001) min, conversions (7 vs. 0 p = 0.002), and differed. Stricture (7 vs. 2 p = 0.146) and endoscopic balloon dilation (12 vs. 4 p = 0.083) rates at a follow-up of 12 (8–18) months did not differ significantly. Time to presentation after surgery for the strictures was 36.5 (33–42) vs. 26.5 (24–29) days in the CSA and in the LSA arms, respectively. The percentage of excess body weight loss at 1 year was similar (80% vs. 78%). CONCLUSIONS: This underpowered study did not detect a significant difference in stricture rates at the GJA after CSA or LSA. Strictures were safely and successfully treated by endoscopic balloon dilation. Larger studies with a widely accepted classification of GJA stricture would be appropriate.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
