Comparing Stenosis rate of Gastrojejunal anastomosis between 21-mm and 25-mm circular stapler in Laparoscopic Roux-en-y Gastric bypass: A preliminary report of randomized clinical trial

Jakrapan Wittayapairoch, MD1, Pakkavuth Chanswangphuvana, MD2, Ajjana Techagampuch, MD2, Narong Boonyagard, MD2, Pondech Vichajarn, MD2, Rapheephat Tanomphetsanga, MD2, Krit Kitisin, MD2, Suppa-ut Pungpapong, MD2, Chadin Tharavej, MD2, Patpong Navicharern, MD2, Suthep Udomsawaengsup, MD2. 1Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 2Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Introduction: Gastrojejunal anastomosis stenosis is the most common early complication in Laparoscopic Roux-en-y Gastric bypass (LRYGB), The stenosis rate appears to be correlated with the size of circular stapler.

Method and procedures: Morbid obese patients in King Chulalongkorn memorial hospital, scheduled for LRYGB, were randomized to undergo gastrojejunal anastomosis (GJA) by 21-mm or 25-mm circular-stapler. Stenosis of GJA is defined as patient complaints vomiting and/or dysphagia with liquid or meal leading to endoscope 12 weeks postoperatively. A stenosis was confirmed by inability to pass a gastroscope through GJA. Incidence of stenosis of GJA, %EWL at 12 months after surgery, perioperative complications and mortality were evaluated.

Results: 68 patients were randomized to 35 in 21-mm group and 33 in 25 group. There was no different in demographic data. Stenosis of GJA was report in 5 patients of 21-mm group and 2 patients of 25-mm group (14.28% vs 6.06% respectively, p=0.26), %EWL at 12 months was similar between both groups.

Conclusions: In this preliminary report 21-mm and 25-mm circular stapled GJA are safe and effective for LRGB. There was no significant rate of stenosis after GJA. However long-term follow-up is mandatory to address effect of size of circular stapler on stenosis rate and weight loss.

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