Circular- vs. linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass

Different surgical techniques have been developed for the gastrojejunostomy (GJS) in laparoscopic Roux-en-Y gastric bypass (LRYGBP) with the anastomosis performed in a circular-stapled, linear-stapled, or totally hand-sewn way. No technique seems superior to the other as no consistent data on weight loss or complication rates were described.

A matched-pair study was conducted including a total of 150 patients, who underwent primary antegastric, antecolic LRYGBP between August 2003 and February 2007. Early weight loss and the incidence of GJS strictures or leaks and wound infections were compared between circular-stapled anastomosis (CSA) and linear-stapled anastomosis (LSA). Both groups were matched for age, sex, and body mass index.

Excess weight loss at 3 months was slightly better with the CSA (p = 0.002) and comparable thereafter. Percentage of excess weight loss at 6, 12, and 24 months was 55.9 +/- 17.5% vs. 51.2 +/- 14.5%, 69.5 +/- 20.9% vs. 71.4 +/- 22.6%, and 70.8 +/- 22.4% vs. 73.2 +/- 23.4%, respectively (CSA vs. LSA). Strictures at the GJS were found only in the CSA group (n = 4), and leaks were found in one patient of the CSA group. More wound infections were observed in patients of the CSA group (ten vs. one).

CSA and LSA lead to comparable early weight loss in LRYGB. Thus, the technique is the surgeon's choice. In CSA, a higher incidence of GJS strictures and wound infections was observed. As weight regain following LRYGBP is commonly observed after at least 3 years, a longer follow-up is needed to compare the incidence of weight regain in circular- vs. linear-stapled GJS.