title: Influence of circular stapler diameter on postoperative stenosis after laparoscopic gastrojejunal anastomosis in morbid obesity.
abstract: BACKGROUND
  The aim of the present study was to provide a pooled analysis of individual small trials comparing 21-mm and 25-mm circular stapled laparoscopic gastrojejunal (GJ) anastomosis in morbid obesity surgery.
  
  
  METHODS
  A systematic literature search of MEDLINE, Embase, and Cochrane library databases was performed to identify all relevant studies comparing 21-mm and 25-mm circular stapled laparoscopic GJ anastomosis in morbid obesity surgery. The primary outcomes were GJ stenosis and the interval to GJ stenosis. The secondary outcomes were the estimated weight loss, GJ diameter, and the number of endoscopic dilations. Pooled odds ratios were calculated for categorical outcomes and weighted mean differences for continuous outcomes.
  
  
  RESULTS
  Five trials were included, comprising 1217 patients (393 with 21-mm and 824 with 25-mm circular GJ anastomoses). The primary outcome analysis revealed a significantly increased incidence of intraluminal stenosis associated with the 21-mm circular stapler (pooled odds ratio 3.54; P < .0001). The secondary outcome analysis revealed a significantly reduced GJ anastomotic diameter on endoscopy with the 21-mm circular stapler group (weighted mean difference -1.67; P = .002). Statistical analysis revealed no significant difference between the groups for the interval to stenosis, number of endoscopic dilations, and estimated weight loss.
  
  
  CONCLUSIONS
  The results of the present pooled analysis have demonstrated a significantly increased incidence of symptomatic stenosis associated with the 21-mm circular stapler compared with the 25-mm stapler. This serves as evidence to validate the preferential selection of the 25-mm circular stapler for laparoscopic GJ bypass.
authors.affiliation: Department of General Surgery, University College London Hospital, London, United Kingdom. sheraz_markar@hotmail.com
authors.forename: Sheraz R
authors.initials: SR
authors.lastname: Markar
authors.forename: Marta
authors.initials: M
authors.lastname: Penna
authors.forename: Vishal
authors.initials: V
authors.lastname: Venkat-Ramen
authors.forename: Alan
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: Majid
authors.initials: M
authors.lastname: Hashemi
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000295:instrumentation; D002986:Clinical Trials as Topic; D004867:Equipment Design; D005260:Female; D015390:Gastric Bypass / Q000295:instrumentation*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology*; D007579:Jejunal Diseases / Q000209:etiology*; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D013270:Stomach / Q000601:surgery; D013272:Stomach Diseases / Q000209:etiology*; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000295:instrumentation