title: Linear compared to circular stapler anastomosis in laparoscopic Roux-en-Y gastric bypass leads to comparable weight loss with fewer complications: a matched pair study.
abstract: OBJECTIVE
  In the course of laparoscopic Roux-en-Y gastric bypass (LRYGB), a tight gastroenterostomy (GE) may lead to higher weight loss but possibly to an increase of local complications such as strictures and ulcers. Different operative techniques for Roux-en-Y reconstruction may also influence the rate of internal hernias, a typical late complication of LRYGB. The objective of this study was to compare weight loss, rates of strictures, internal hernias, and ulcerations of linear versus circular stapler anastomosis.
  
  
  METHODS
  Retrospective analysis of prospectively collected data in a 3:1-matched pair study. A total of 228 patients with a minimal follow-up of 2 years were matched according to BMI at baseline, age, and gender. The follow-up rate was 100 % at 1 and 2 years postoperatively; the mean follow-up time was 3.8 ± 1.63 years. In group C (circular), 57 patients were operated with a 25-mm circular stapler technique (average BMI 44.7 ± 5.18 kg/m(2), age 44.1 ± 10.8 years, 80.7 % female). In group L (linear), 171 patients were operated using a linear stapler (approximately 30 mm, average BMI 43.8 ± 5.24 kg/m(2), age 43.7 ± 12.5 years, 70.8 % female). A propensity score matching and a logrank test were used for statistical analysis.
  
  
  RESULTS
  The average excessive BMI loss (EBMIL) after 1 year was not statistically different (70.6 ± 20.2 % in group C vs 72.5 ± 20.4 % in group L) as well as after 2 years (71.6 ± 22.5 % in group C vs 74.6 ± 19.6 % in group L). The average operation time was 155 ± 53 min in group C and 109 ± 57 min in group L (p = 0.0001). In group L, patients had significantly lower overall stricture rates at the GE compared to group C (0 [0 %] vs. 4 [7 %], p = 0.0004), a lower rate and severity of internal hernias (10 [5.8 %] vs. 7 [12.3 %] p = 0.466), and equal local ulcerations rates (3 [1.8 %] vs. 1 [1.8 %] p = 0.912).
  
  
  CONCLUSIONS
  Linear stapler anastomosis in LRYGB compared to circular anastomosis leads to equal weight loss and less strictures. The lower rate of internal hernias in linear stapler anastomosis was not significantly different.
authors.affiliation: Department of Surgery, St. Claraspital AG, Kleinriehenstrasse 30, CH-4058, Basel, Switzerland.
authors.forename: Romano
authors.initials: R
authors.lastname: Schneider
authors.affiliation: Department of Surgery, St. Claraspital AG, Kleinriehenstrasse 30, CH-4058, Basel, Switzerland.
authors.forename: Jörn-Markus
authors.initials: JM
authors.lastname: Gass
authors.affiliation: Department of Surgery, St. Claraspital AG, Kleinriehenstrasse 30, CH-4058, Basel, Switzerland.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Kern
authors.affiliation: Interdisciplinary Center of Nutritional and Metabolic Diseases, St. Claraspital AG, Kleinriehenstrasse 30, CH-4058, Basel, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Peters
authors.affiliation: Interdisciplinary Center of Nutritional and Metabolic Diseases, St. Claraspital AG, Kleinriehenstrasse 30, CH-4058, Basel, Switzerland.|Endocrine Research Unit, Medizinische Klinik-Innenstadt, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Slawik
authors.affiliation: Interdisciplinary Center of Nutritional and Metabolic Diseases, St. Claraspital AG, Kleinriehenstrasse 30, CH-4058, Basel, Switzerland.
authors.forename: Martina
authors.initials: M
authors.lastname: Gebhart
authors.affiliation: Department of Surgery, St. Claraspital AG, Kleinriehenstrasse 30, CH-4058, Basel, Switzerland. ralph.peterli@claraspital.ch.
authors.forename: Ralph
authors.initials: R
authors.lastname: Peterli
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Bariatric surgery; Circular stapler; Complications; Internal hernias; Laparoscopic gastric bypass; Linear stapler; Strictures; Ulcers; Weight loss