Comparison of Stricture Rates using Three Different Gastrojejunostomy Anastamotic Techniques in Laparoscopic Roux-en-Y Gastric Bypass

Azam Qureshi, MD, Mujjahid Abbas, MD, Lindsay Cumella, BS, J J Choi, MD, P. Vemulapalli, MD, D. R Camacho, MD. Montefiore Medical center, Bronx, NY.

Introduction: No one gastrojejunostomy anastomosis technique (GJA) in Laparoscopic Roux-en-Y gastric bypass (LRYGB) is currently preferred over another. Bendewald et al confirmed that there was no difference in anastomotic stricture rates when comparing hand-sewn (HS), linear-stapled (LS), and circular-stapled (CS) GJA techniques. We present and analyze our own institutional data to readdress stricture rates.

Methods: From January 2010 to January 2013 860 consecutive patients underwent LRYGB using HS, LS, and CS anastomotic techniques at a single institution. All patients in this study were followed for a duration of 60 days to see if they had a complication of a stricture within this time period. Hospital records were retrospectively reviewed. Stricture complications were defined as those patients who had a clinical exam suspicious for stricture which were then confirmed by endoscopy.

Results: Preoperative demographics, length of hospital stay, and postoperative follow-up did not differ between the three groups. The most common technique employed was LS (n=429, 49.8%), followed by CS (n=254, 29.5%) and HS (n=177, 20.6%), respectively. Using multivariate analysis, there was a significant difference in the rate of strictures between the anastomotic techniques (LS 3.96%, HS 2.26%, CS 0.394%, p=0.0163).

Conclusions: Our data shows that the discussion of which anastomotic technique is superior should be reopened given the statistically significant low rate of strictures in patients who underwent LRYGB with a CS anastomosis in comparison to LS and HS anastomoses.

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