title: Comparison between circular- and linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass--a cohort from the Scandinavian Obesity Registry.
abstract: BACKGROUND
  Although laparoscopic Roux-en-Y gastric bypass (LRYGB) is a common bariatric procedure worldwide, no consensus on the optimal technique for the gastrojejunostomy (GJ) has been reached. Circular stapling (CS) immediately results in a GJ of standardized width, whereas linear stapling (LS) requires a technically challenging closure of the stapler defect. The aim was to study differences in outcomes between CS and LS.
  
  
  METHODS
  Nationwide Swedish cohort.
  
  
  METHODS
  The Scandinavian Obesity Registry (SOReg) included prospective data from 34,284 primary LRYGB patients operated on in 2007-2013. We studied operative time, length of hospital stay, postoperative complications, and percent excess body mass index loss (%EBMIL) after 1 year. Outcomes were assessed through multivariate analysis adjusting for gender, age, preoperative body mass index (BMI), and diabetes.
  
  
  RESULTS
  Preoperatively the groups were similar (40.9 yr, BMI 42.4 kg/m(2), 76% female). For CS and LS, operative time and hospital stay were 114 and 73 minutes (P<.001) and 4.6 and 2.0 days (P<.001), respectively. Using LS as a reference, adjusted odds ratio (OR) for CS patients to have anastomotic leakage was 2.8 (95% CI 1.5-5.0), postoperative hemorrhage 1.9 (95% CI 1.2-2.9), wound complication 9.7 (95% CI 6.8-13.9), and marginal ulcer 3.1 (95% CI 1.8-5.3). The %EBMIL at 1 year was 80% for both techniques and 31% of total weight was lost. Follow-up rate at 6 weeks and 1 year was 96% and 73%, respectively.
  
  
  CONCLUSIONS
  CS was found to be associated with disadvantages regarding operative time, hospital stay, and postoperative complications compared with LS.
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. Electronic address: dedholm@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Edholm
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Sundbom
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000453:epidemiology*; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D017792:Surgical Stapling / Q000379:methods*; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Circular stapler; Complications; Gastric bypass; Gastrojejunostomy; Laparoscopic gastric bypass; Morbid obesity; Stapling technique