title: First experiences with A circular stapled gastro-jejunostomy by a new transorally introducible stapler system in laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  The only effective treatment for patients with morbid obesity is surgery. Laparoscopic bariatric surgery has become quite popular in attempts to decrease the morbidity associated with laparotomy. The aim of this study was to assess the safety and efficiency by using SurgASSIST(R) for performing the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass (RYGBP). The variables were compared with the results using the standard laparoscopic circular end-to-end anastomotic stapler (CEEA(R)).
  
  
  METHODS
  After randomization, the gastro-jejuostomy of RYGBP was performed in ten patients by transabdominal introduced circular stapler (group A) and in ten patients by transorally introduced circular stapler (SurgASSIST(R); group B) via five-port laparoscopy. A prospective 12-month postoperative follow-up including documentation of minor and major complication as well as weight loss and body composition is done every 8 weeks.
  
  
  RESULTS
  The average body mass index (BMI, 52 kg/m(2)) and the other baseline characteristics were equally distributed in both groups. There was no difference in reduction of BMI, excess weight loss, and fat mass in both groups. The rate of port site wound infection in group A was significantly higher (p = 0.03) when compared to group B. There was no anastomotic leak or stricture postoperatively in both groups.
  
  
  CONCLUSIONS
  Performing of a gastrojejunostomy in RYGBP by SurgASSIST is a safe and feasible method in comparison to conventional circular stapler systems. The advantage of SurgASSIST is the avoidance to introduce the stapler through the abdominal wall and, by this, a possible port site wound infection. Further prospective studies have to be performed to verify the advantages of the SurgASSIST in comparison to conventional circular stapler systems.
authors.affiliation: Department of Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany. edward.shang@urz.uni-heidelberg.de.
authors.forename: Edward
authors.initials: E
authors.lastname: Shang
authors.affiliation: Department of Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Hasenberg
authors.affiliation: Department of Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Magdeburg
authors.affiliation: Department of Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Keese
authors.affiliation: Department of Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Post
authors.affiliation: Department of Surgery, Krankenhaus Sachsenhausen, Frankfurt am Main, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Weiner