title: The impact of circular stapler diameter on the incidence of gastrojejunostomy stenosis and weight loss following laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Gastrojejunostomy stenosis after laparoscopic Roux-en-Y gastric bypass is a common occurrence. The incidence varies widely among reported series. We evaluated the impact of circular stapler size on the rate of stenosis and weight loss.
  
  
  METHODS
  Our initial technique utilized a 21-mm circular stapler to construct the gastrojejunostomy. We switched to a 25-mm stapler after a large preliminary experience. Stenosis was confirmed by endoscopy in patients complaining of the inability to eat or excessive vomiting, and was defined as a gastrojejunostomy diameter less than that of a therapeutic endoscope (11-mm).
  
  
  RESULTS
  Stenosis occurred in 23 of 145 patients (15.9%) with a 21-mm gastrojejunostomy. Five of 81 patients with a 25-mm circular stapled anastomosis have developed a stenosis (6.2%, p = 0.03). Weight loss was similar for each sized stapler at 6 and 12 months.
  
  
  CONCLUSIONS
  The use of a 25-mm circular stapler in laparoscopic gastric bypass is preferable to a 21-mm stapler. The larger stapler is associated with a significantly decreased incidence of gastrojejunostomy stenosis without compromising early weight loss.
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, K4/762 Clinical Science Center, Madison, WI 53792-7375, USA. gould@surgery.wisc.edu
authors.forename: Jon Charles
authors.initials: JC
authors.lastname: Gould
authors.forename: Michael
authors.initials: M
authors.lastname: Garren
authors.forename: Valerie
authors.initials: V
authors.lastname: Boll
authors.forename: James
authors.initials: J
authors.lastname: Starling
mesh_terms: D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology; D004867:Equipment Design; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007582:Jejunostomy / Q000009:adverse effects*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D013528:Surgical Staplers; D015431:Weight Loss