Shorter circular staple is height associated with lower anastomotic stricture rate in laparoscopic gastric bypass

Anastomotic stenosis, leak, and hemorrhage are common stapler-related complications of laparoscopic Roux-en-Y gastric bypass. In May 2007, we transitioned from a 25-mm diameter, 4.8-mm-height circular stapler to a 25-mm, 3.5-mm-height circular stapler. We hypothesized that the staple height would be associated with a decreased incidence of perioperative complications.

The records of 360 consecutive patients who had undergone laparoscopic Roux-en-Y gastric bypass from May 1, 2006 to March 31, 2008 were retrospectively abstracted. The National Surgical Quality Improvement Project and Michigan Bariatric Surgery Collaborative databases were used to collect the patient demographics and track complications of laparoscopic Roux-en-Y gastric bypass. Data were collected on the rates of anastomotic stenosis requiring dilation of the gastrojejunostomy, anastomotic leak, hemorrhage requiring transfusion, and wound infection. Patients with a 4.8-mm staple height gastrojejunostomy were compared with those with a 3.5-mm staple height gastrojejunostomy for differences in complications.

The groups were similar with respect to age, gender, body mass index, hypertension, hyperlipidemia, diabetes, sleep apnea, and surgery duration. In the 4.8- and 3.5-mm staple height groups, 15% and 6.1% required gastrojejunal dilation, respectively (P = .01). A trend was seen toward a decrease in postoperative hemorrhage (5% versus 2.8%) with the shorter staple height. No anastomotic leaks occurred, and the incidence of wound infection (1.7% versus 2.2%) was similar between the 2 groups.

In the present study, the use of a 25-mm, 3.5-mm staple height circular stapler was associated with a decreased rate of anastomotic stenosis.