title: Impact of gastrojejunostomy diameter on long-term weight loss following laparoscopic gastric bypass: a follow-up study.
abstract: BACKGROUND
  Stenosis of the gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass is a common occurrence. We have previously presented data demonstrating that the use of a 25-mm circular stapler results in a decreased incidence of stenosis compared to the results of a 21-mm circular stapler (6.2 vs. 15.9%, P=0.03). One potential drawback of the larger-diameter stapler is the possibility for impaired long-term weight loss due to decreased restriction. We sought to determine the impact of circular stapler diameter on excess weight loss up to 5 years after surgery.
  
  
  METHODS
  Our initial technique for creating the gastrojejunostomy after laparoscopic gastric bypass involved the transgastric passage of a 21-mm circular stapler anvil (group 1). After a large initial experience, we switched to a 25-mm circular stapler (group 2). Follow-up data were entered prospectively into a computer database. Weight loss was recorded as percent of excess weight lost. Only patients with follow-up beyond 3 years postoperatively were eligible for inclusion.
  
  
  RESULTS
  Group 1 consisted of 145 consecutive patients and group 2 consisted of 116 consecutive patients. There was no significant difference in weight loss between the groups at 3 (66.1 vs. 65.2%, P=0.76, n=134), 4 (66.4 vs. 58.6%, P=0.1, n=66), and 5 years after gastric bypass (62.7 vs. 57.5%, P=0.24, n=75).
  
  
  CONCLUSIONS
  The use of a 25-mm circular stapler in laparoscopic gastric bypass operations instead of a 21-mm stapler does not result in significantly different long-term weight loss. The 25-mm stapler is preferred with our technique.
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
authors.forename: Carter
authors.initials: C
authors.lastname: Smith
authors.forename: Michael
authors.initials: M
authors.lastname: Garren
authors.forename: Jon
authors.initials: J
authors.lastname: Gould
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013528:Surgical Staplers; D016896:Treatment Outcome; D015431:Weight Loss