title: Smaller staple height for circular stapled gastrojejunostomy in laparoscopic gastric bypass: early results in 1,074 morbidly obese patients.
abstract: BACKGROUND
  Anastomotic leaks, stenosis, and bleeding from the gastrojejunal anastomosis (GJA) after gastric bypass may carry high morbidity and mortality. To date, the standard operation with the circular stapler (CS) used the 25 mm with a staple height of 4.8 mm. We present herein our experience with the 3.5-mm staple height.
  
  
  METHODS
  A total of 1,074 morbidly obese patients who underwent fully stapled laparoscopic Roux-en-Y Gastric Bypass over a period of 18 months were included in the study. Mean body mass index was 41.9 (range 28.6-70.7). Mean age was 40.9 years (range 15-74 years). Mean operating time was 73 min (range 43-210 min) and the mean length of stay was 4.2 days (range 1-25 days). The 30-day complication rate associated with GJA was prospectively analyzed.
  
  
  RESULTS
  Twenty patients (1.86%) developed postoperative bleeding. Four developed GJA bleeding (0.37%). One leak was recorded from the vertical staple line of the gastric pouch, but no leaks from the GJA were seen. Conversion to open approach was required in two patients (0.18%). Reoperation and readmission rates were 1.7% and 1.8%, respectively. Perioperative complications were observed in 34 patients (3.1%). One case of clinical GJA stenosis was detected in a mean follow-up of 10.5 months (range 5-20 months). There was no mortality in our series.
  
  
  CONCLUSIONS
  Compared to our previous experience with 4.8 mm CS, creating the GJA using a smaller staple height significantly reduced the bleeding rate and seems to be a safe technique that potentially reduces other complications related to the GJA as reported in the literature.
authors.affiliation: Department of General Surgery A, Hillel Yaffe Medical Center, Hadera, Israel. nassers@hy.health.gov.il
authors.forename: Nasser
authors.initials: N
authors.lastname: Sakran
authors.forename: Ahmad
authors.initials: A
authors.lastname: Assalia
authors.forename: Ahud
authors.initials: A
authors.lastname: Sternberg
authors.forename: Yoram
authors.initials: Y
authors.lastname: Kluger
authors.forename: Anton
authors.initials: A
authors.lastname: Troitsa
authors.forename: Eran
authors.initials: E
authors.lastname: Brauner
authors.forename: Sebastiaan
authors.initials: S
authors.lastname: Van Cauwenberge
authors.forename: Marieke
authors.initials: M
authors.lastname: De Visschere
authors.forename: Bruno
authors.initials: B
authors.lastname: Dillemans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D015390:Gastric Bypass; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011446:Prospective Studies; D017792:Surgical Stapling / Q000379:methods*; D013997:Time Factors; D055815:Young Adult