title: Differences in early complications between circular and linear stapled gastrojejunostomy in laparoscopic gastric bypass.
abstract: BACKGROUND
  Laparoscopic gastric bypass (LGBP) is the most common bariatric procedure worldwide. The gastrojejunostomy can be stapled with a circular or linear stapler, each with their own specific advantages. We have evaluated differences in postoperative complications between the two techniques.
  
  
  METHODS
  We studied operative data and postoperative complications in 560 patients (79.8 % females, median age 42, BMI 42.5) operated with LGBP between 2008 and 2012 at our center. The gastrojejunostomy was initially performed using a circular stapler (CS) in 288 patients and later by linear stapler (LS) in 272. Complications, operative time, and length of stay were retrieved from our database. The risk of developing a port site infection was evaluated with multivariate logistic regression.
  
  
  RESULTS
  Port site infections were more common with CS than LS, 5.2 and 0.4 %, respectively (p < 0.01). Multivariate analysis demonstrated CS to be an independent risk factor for port site infections (OR 16.3 (2.09-126), p < 0.01), as well as for stomal ulcers (OR 10.1, 1.15-89, p = 0.04). Major postoperative complications remained unchanged (anastomotic leak 1.0 vs. 1.1 %, abscess 0.7 vs. 0.4 %), while operative time and length of stay were found to be shorter using the LS (122 vs. 83 min, p < 0.001 and 4 vs. 3 days, p < 0.001).
  
  
  CONCLUSIONS
  The linear stapled technique yielded lower incidence of port site infections, probably by avoiding the passage of a contaminated circular stapler through the abdominal wall. No difference in major complications was seen, but operative time was shorter using a linear stapler instead of a circular stapler.
authors: Department of Surgical Sciences, Uppsala University, 75185, Uppsala, Sweden, eduardo.sima@surgsci.uu.se.
authors: E
authors: E
authors: Sima
authors: J
authors: J
authors: Hedberg
authors: A
authors: A
authors: Ehrenborg
authors: M
authors: M
authors: Sundbom
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000453:epidemiology*; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*; D013530:Surgical Wound Infection / Q000453:epidemiology*