Complications at gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass: comparison between 21- and 25-mm circular staplers.
BACKGROUND
Complications involving the gastrojejunostomy (GJ) after laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity frequently result in hospital readmission and additional procedures. The purpose of this study was to compare the complication rate of GJ performed with the 21- and 25-mm circular staplers.


METHODS
We retrospectively reviewed the incidence of stricture, bleeding, ulcer, and leak at the GJ in 438 consecutive patients who had undergone LRYGB.


RESULTS
The GJ was performed using the 25-mm stapler in 374 patients and the 21-mm stapler in 64 patients. Of the 50 anastomotic complications, 11 (17.2%) occurred with the 21-mm stapler, including 6 strictures (9.4%), 4 ulcers (6.3%), and 1 leak (1.6%), and 39 (10.4%) with the 25-mm stapler, including 11 strictures (2.9%), 6 acute bleeding episodes (1.6%), 19 ulcers (5.4%), and 4 leaks (1.1%). Rehospitalization was required in 9 patients (47%) with a pure stricture and 17 (74%) with ulcers. The incidence of pure stricture was significantly greater in the GJ performed with the 21-mm than with the 25-mm stapler (P = .026, Fisher's exact test). No difference was found in the rate of acute bleeding, leak, or ulcer between the 2 groups. All strictures resolved with balloon dilation. Four patients with stenotic ulcers that failed to respond to dilation and medications required operative revision. No difference was found in postoperative weight loss between the 2 groups.


CONCLUSIONS
Anastomotic complications were recognized in 50 (11.4%) of 438 patients who had undergone LRYGB in which the GJ was performed using circular staplers, including 11 (17.2%) with the 21-mm and 39 (10.2%) with the 25-mm stapler. The rate of anastomotic stricture was significantly lower using the 25-mm circular stapler.
Department of Surgery, University Medical Center at Princeton, Princeton, New Jersey 08852, USA.
W Jay
WJ
Suggs
Wael
W
Kouli
Michael
M
Lupovici
Wai Yip
WY
Chau
Robert E
RE
Brolin
D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D002404:Catheterization; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D005763:Gastroenterostomy / Q000009:adverse effects*; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D015994:Incidence; D007582:Jejunostomy / Q000009:adverse effects*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D010359:Patient Readmission; D012086:Reoperation; D012189:Retrospective Studies; D013528:Surgical Staplers / Q000009:adverse effects*; D014456:Ulcer / Q000209:etiology