title: Comparison of gastrojejunal anastomosis techniques in laparoscopic Roux-en-Y gastric bypass: gastrojejunal stricture rate and effect on subsequent weight loss.
abstract: BACKGROUND
  Different gastrojejunal anastomotic (GJA) techniques have been described in laparoscopic Roux-en-Y gastric bypass (LRYGB). There is conflicting data on whether one technique is superior to the other. We aimed to compare hand-sewn (HSA), circular-stapled (CSA) and linear-stapled (LSA) anastomotic techniques in terms of stricture rates and their impact on subsequent weight loss.
  
  
  METHODS
  A prospectively collected database was used to identify patients undergoing LRYGB surgery between March 2005 and May 2012. Anastomotic technique (HSA, CSA, LSA) was performed according to individual surgeon preference. The database recorded patient demographics, relevant comorbidities and the type of GJA performed. Serial weight measurements and percentage excess weight loss (%EWL) were available at defined follow-up intervals.
  
  
  RESULTS
  Included in the data were 426 patients, divided between HSA (n = 174, 40.8%), CSA (n = 110, 25.8%) and LSA (n = 142, 33.3%). There was no significant difference in the stricture rates (HSA n = 17, 9.72%; CSA n = 9, 8.18%; LSA n = 8, 5.63%; p = 0.4006). Weight loss was similar between the three techniques (HSA, CSA and LSA) at 3 months (40.6% ± 16.2% vs 35.92% ± 21.42% vs 48.21 % ± 14.79%; p = 0.0821), 6 months (61.48% ± 23.94% vs 58.16 % ± 27.31% vs 60.18% ± 22.26%; p = 0.2296), 12 months (72.94% ± 19.93% vs 69.72 ± 21.42% vs 66.05% ± 17.75%; p = 0.0617) and 24 months (73.29% ± 22.31% vs 68.75 % ± 24.71% vs 69.40% ± 23.10%; p = 0.7242), respectively. The stricture group lost significantly greater weight (%EWL) within the first 3 months compared to the non-stricture group (45.39% ± 16.82 % vs 39.22 % ± 21.93%; p = 0.0340); however, this difference had resolved at 6 months (61.29% ± 18.50 % vs 59.79% ± 23.03%; p = 0.8802) and 12 months (71.59 % ± 18.67 % vs 68.69 % ± 22.19 %; p = 0.5970).
  
  
  CONCLUSIONS
  There was no significant difference in the rate of strictures between the three techniques, although the linear technique appears to have the lowest requirement for post-operative dilatation. The re-intervention rate will, in part, be dictated by the threshold for endoscopy, which will vary between units. Weight loss was similar between the three anastomotic techniques. Surgeons should use techniques that they are most familiar with, as stricture and weight loss rates are not significantly different.
authors.affiliation: Bariatric and Metabolic Surgery Unit, Chelsea and Westminster Hospital NHS Trust, London, UK, sangoh01@gmail.com.
authors.forename: Sangoh
authors.initials: S
authors.lastname: Lee
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Davies
authors.forename: Sameer
authors.initials: S
authors.lastname: Bahal
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Cocker
authors.forename: Gianluca
authors.initials: G
authors.lastname: Bonanomi
authors.forename: Jeremy
authors.initials: J
authors.lastname: Thompson
authors.forename: Evangelos
authors.initials: E
authors.lastname: Efthimiou
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods; D003251:Constriction, Pathologic / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D013536:Suture Techniques; D016896:Treatment Outcome; D015431:Weight Loss