Gastrojejunostomy Stenosis Following Laparoscopic Roux-en-Y Gastric Bypass: 21 Vs. 25-mm Circular Stapler, a Follow-up Study of Long Term Weight Loss.

Introduction: Stenosis of the gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass is a common occurrence. We have previously presented data demonstrating that the use of a 25-mm circular stapler results in a decreased incidence of stenosis when compared to a 21-mm circular stapler. One potential drawback of the larger diameter stapler is the possibility for impaired long term weight loss due to decreased restriction. We sought to determine the impact of circular stapler diameter on excess weight loss up to 5 years after surgery.

Methods: Our initial technique for creating the gastrojejunostomy after laparoscopic gastric bypass involved the transgastric passage of a 21-mm circular stapler anvil (Group 1). After a large initial experience, we switched to a 25-mm circular stapler (Group 2). The remainder of our technique did not change. In all cases, the Roux limb was both antecolic and antegastric. Follow-up data was entered prospectively into a computerized database. Weight loss was recorded as percent of excess weight lost (PEWL). Only patients with follow-up beyond 3 years postoperatively were eligible for inclusion. The weight loss results were compared with a student’s T test. The rate of stenosis was compared with Fisher’s exact test.

Results: Group 1 consisted of 145 consecutive patients and Group 2 consisted of 116 consecutive patients. Stenosis occurred in 24 (16.5 %) and 10 (8.62 %) patients respectively and was lower in the 25-mm stapler group (p = 0.042). Long-term weight loss was evaluated at 3, 4 and 5 years post-operatively and is shown in Table 1.

Table 1. Long term weight loss

3 year PEWL4 year PEWL5 year PEWL

There was no significant difference in weight loss between the groups at 3, 4, or 5 years after gastric bypass. The Patient groups were equal in BMI (Group 1: 49.8 +/- 7.0 vs. Groups 2: 49.6 +/- 6.1, p = 0.79) and age (44.4 +/- 10.6 yrs vs. 44.2 +/- 10.5 yrs, p = 0.92)

Conclusions: The use of a 25-mm circular stapler in laparoscopic gastric bypass operations instead of 21-mm results in a lower incidence of stenosis and does not result in significantly different long term weight loss. The 25-mm stapler is the preferred technique with our technique.

Session: Podium Presentation

Program Number: S060

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