Comparison of staple line reinforcement with nonreinforcement in Roux-en-Y gastric bypass surgery: a meta-analysis

Laparoscopic Roux-en-Y gastric bypass (RYGB) is a commonly used surgical procedure for the treatment of morbid obesity. Although surgical techniques continue to advance, the incidence of postoperative complications remain challenging to surgeons. This study aimed to systematically evaluate the effectiveness of staple line reinforcement (reinforced) versus nonreinforcement (nonreinforced) on postoperative complications (bleeding, leakage, stricture) in RYGB, and provide evidence-based basis for clinical surgical decision-making.

Databases (PubMed, Embase, and Cochrane Library) were searched for clinical studies published between 2003 and 2025 comparing staple line reinforcement versus nonreinforcement in RYGB, including randomized controlled trials and cohort studies. Pooled risk ratios (RRs) or mean differences were calculated using fixed- or random-effects models based on heterogeneity. Study quality was assessed using the Newcastle-Ottawa Scale for cohort studies and the Cochrane risk of bias tool for randomized trials. Sensitivity analyses excluded studies including open RYGB and were further stratified by stapler type and mesh material.

A total of 10 studies was included, including 3 randomized controlled trials and 7 cohort studies, involving 3680 patients (1889 in the reinforced group and 1791 in the nonreinforced group). The risk of bleeding complications in the reinforced group was significantly lower than that in the nonreinforced group (RR = .23, 95% confidence interval [CI] [.09, .60], P = .002) with low heterogeneity (I² = 0%, P = .89). There was no statistically significant difference in anastomotic leakage between the two groups (RR = .30, 95% CI [.04, 2.13], P = .23) with high heterogeneity (I² = 73%, P = .002). Staple line reinforcement was associated with a significant reduction in the risk of postoperative stricture between the two groups (RR = .25, 95% CI [.07, .85], P = .03) with high heterogeneity (I² = 60%, P = .03). Sensitivity and subgroup analyses indicated that the primary findings were not influenced by the surgical approach (open vs laparoscopic), stapler type, or mesh materials.

Staple line reinforcement in RYGB was associated with reduction in the risk of postoperative bleeding and stricture. However, it did not demonstrate a clear effect on the risk of postoperative leakage.