title: Laparoscopic Roux-en-Y gastric bypass with linear cutter technique: comparison of four-row versus six-row cartridge in creation of anastomosis.
abstract: BACKGROUND
  Morbid obesity is refractory to medical treatment. The introduction of laparoscopic linear staplers in the early 1990s contributed to the development of the laparoscopic Roux-en-Y gastric bypass technique. Many series have compared different brands of circular and linear staplers. The purpose of this study was to evaluate the 4-row versus 6-row endoscopic staplers in laparoscopic Roux-en-Y gastric bypass for creation of the anastomosis.
  
  
  METHODS
  Between July 2000 and April 2004, 1240 patients underwent laparoscopic Roux-en-Y gastric bypass. The 4-row linear stapler was used in the first 664 cases (group 1) and the 6-row stapler in the latter 576 patients (group 2) to create the anastomosis. The medical records of those patients who developed leaks, gastrogastric fistulas, strictures, or bleeding were reviewed. Strictures were diagnosed using radiologic or endoscopic techniques.
  
  
  RESULTS
  Leaks were more frequent in group 2 than in group 1 (1.56% versus 1.05%, respectively, P = .46). Documented bleeding occurred in 15 and 13 patients in groups 1 and 2, respectively (2.26% for both). Strictures were diagnosed in 7.68% of patients in group 1 (51 gastrojejunostomy and 4 jejunojejunostomy), and in 4.3% of those in group 2 (25 gastrojejunostomy stenosis, P = .017). Gastrogastric fistulas were found in 5 patients (.75%) in group 1 and 6 (1.04%) in group 2.
  
  
  CONCLUSIONS
  Using a 6-row instead of a 4-row linear cutter technique to create the anastomosis yielded similar results, but the stricture rate at the gastrojejunal anastomosis was significantly lower with the newer, 6-row staplers.
authors.affiliation: Bariatric Institute, Cleveland Clinic Florida, Weston, FL 33331, USA. szomsts@ccf.org
authors.forename: Samuel
authors.initials: S
authors.lastname: Szomstein
authors.forename: Oliver C
authors.initials: OC
authors.lastname: Whipple
authors.forename: Natan
authors.initials: N
authors.lastname: Zundel
authors.forename: Patricio
authors.initials: P
authors.lastname: Cal
authors.forename: Raul
authors.initials: R
authors.lastname: Rosenthal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome