The impact of circular stapler diameter on the incidence of gastrojejunostomy stenosis and weight loss following laparoscopic Roux-en-Y gastric bypass.
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.
Gould
Jon Charles
JC
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
Garren
Michael
M
Boll
Valerie
V
Starling
James
J
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