Early results after laparoscopic gastric bypass: EEA vs GIA stapled gastrojejunal anastomosis

Various surgical techniques have been successfully applied to isolated Roux-en-Y gastric bypass (RYGBP). Many surgeons rely on stapling devices for the gastrojejunal (GJ) anastomosis. Early follow-up results were compared for two laparoscopic techniques for GJ anastomosis: circular end-to-end (EEA) and linear cutting (GIA) staplers.

Medical charts were retrospectively reviewed of all patients who had undergone stapled GJ anastomosis for isolated RYGBP over a 2-year period. The jejunal limb used for GJ anastomosis was fashioned at 1 cm / unit body mass index (BMI). Patients were grouped by GJ anastomotic technique, EEA or GIA, and the results compared.

61 patients underwent RYGBP (EEA=32; GIA=29), with no differences in preoperative BMI or co-morbidities. Mean (+/-SD) operative time was shorter for the GIA group (EEA=180+/-56.1 minutes; GIA=145.3+/-27.9 minutes, P=0.003). There were 2 early re-operations in the GIA group for anastomotic leaks. Postoperative complications were not statistically different; however, there was an increased incidence of wound infections in the EEA group vs the GIA group (21.9% vs 6.9%, P=0.08). Follow-up at 6-8 months revealed an average percent excess weight loss of 46.7%+/-12.2% for EEA and 51.4%+/-10.7% for GIA (P=0.25). Length of stay, total hospital costs and operating-room costs were similar (P=0.34, 0.53 and 0.96 respectively).

Operative time was significantly shorter in the GIA group. Complications, length of stay, weight loss and costs were similar between the groups. Selection of anastomotic technique may be based on surgeon preference, operative time, and potential for serious complications.