A Comparitive Study of Gastrojejunal Strictures After Roux-en-Y Gastric Bypass in 3200 Consecutive Patients With a Use of 21-mm vs 25mm Circular Stapler

Atif Iqbal, MD, Mir Ali, MD, Kelly Frances, MD, Phillip Chin, MD, Peter Leport, MD. Leport Surgical Associates, Orange Coast Memorial Medical Center and Fountain Valley Hospital, Fountain Valley, CA.


Gastrojejunal anastomotic strictures remains the most common late complication after Laparoscopic gastric bypass. This is relatively more common with circular –stapled gastrojejunostomy. The objective of this study was to report the incidence of these strictures with the use of 21-mm vs. 25mm circular stapler. We analyzed outcomes of a transabdominal circular-stapled (RYGBP) with evaluation of short and long-term anastomotic complications.
Three thousand two hundred consecutive laparoscopic RYGBP using circular-stapled technique were performed between January 2005 and December 2010 at two community hospitals. A retrospective comparison was made involving the work of four surgeons. Two used 21-mm (A) and other two used 25-mm (B) circular stapler for their gastrojejunostomy anastomosis. Group A reinforced the anastomosis with 3.0 vicryl running stitch, where as Group B used circular seamguards.  Our mean follow up was six months.
Between January 2005 to December 2010, 3200 patients underwent Trans abdominal circular-stapled RYGBP. Thirty five patients (1.7%) developed stricture at the gastrojejunostomy site in group A with the use of 21 mm circular stapler. The total number of patients in that group was 2046. Fourteen patients (1.2%) in group B with 25 mm circular stapler had strictures out of the total 1145. Six patients (0.2%) in group A had recurrent ulcers and two patients (0.09%) underwent surgical repair. Three patient (0.26%) in group B had recurrent ulcers and one patient (0.08%) underwent surgical repair. The p value was calculated by using Chi square and Fisher’s test (P= 0.3).
Symptomatic anastomotic strictures developed in both groups with slightly more stricture rate with 21mm circular stapler vs 25 mm, although it was not of any significant statistical value.

Session Number: Poster – Poster Presentations
Program Number: P414
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