title: Gastrointestinal symptoms, weight loss and patient satisfaction 5 years after gastric bypass: a study of three techniques for the gastrojejunal anastomosis.
abstract: BACKGROUND
  The optimal operative technique in gastric bypass (RYGB) is still under debate. We have studied patient-reported gastrointestinal symptoms and weight loss 5 years after RYGB performed with three different stapling techniques for the gastrojejunal anastomosis (GJ).
  
  
  METHODS
  Out of 593 patients operated with RYGB, 489 patients [80.2% women, body mass index (BMI) 44.9 (33-68) kg/m(2)] answered our 5-year follow-up questionnaire concerning gastrointestinal symptoms (vomiting, reflux, dumping, abdominal pain or diarrhea), weight loss, need for postoperative endoscopic interventions and overall satisfaction with the procedure. We compared the results for three different GJ techniques: linear stapler (LS, n = 103), 21-mm circular stapler (C21, n = 88) and 25-mm circular stapler (C25, n = 298).
  
  
  RESULTS
  Dumping was the most commonly reported symptom (14.1% of all patients on a weekly to daily basis), however, less frequently reported in the C25 group (p < 0.05). Vomiting, prevalent in 2.9% of all patients, was more frequently reported in the C21 group (p < 0.01). No group consistently showed greater weight loss compared to the other two groups. A higher incidence of endoscopic dilatations due to strictures was reported in the C21 group (12.5% compared to 4.5% of all patients, p < 0.05). Overall patient satisfaction was high (88%).
  
  
  CONCLUSIONS
  Our data suggest that the technique for the construction of the GJ in RYGB affects gastrointestinal symptoms 5 years postoperatively. The difference is moderate but indicates that a narrow GJ results in increased frequency of vomiting and need for endoscopic interventions without improving the weight result.
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. eduardo.sima@surgsci.uu.se.
authors.forename: E
authors.initials: E
authors.lastname: Sima
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Hedberg
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Sundbom
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery; D017060:Patient Satisfaction; D014839:Vomiting / Q000209:etiology; D015431:Weight Loss
keywords: Gastric bypass; Gastrointestinal symptoms; Gastrojejunostomy; Long-term results; Stapling technique; Weight loss