Incidence of gastroenterostomy stenosis in laparoscopic Roux-en- Y gastric bypass using 21- or 25-mm circular stapler: a randomized prospective blinded study

• Published in: Surgery for obesity and related diseases Vol. 3; no. 2; pp. 176 - 179
• Main Authors: Fisher, Barry L., M.D., F.A.C.S, Atkinson, James D., M.D., F.A.C.S, Cottam, Daniel, M.D., F.A.C.S
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2007
• Subjects: Adult; Catheterization; Constriction, Pathologic - epidemiology; Constriction, Pathologic - etiology; Constriction, Pathologic - therapy; Endoscopic dilation; Female; Follow-Up Studies; Gastric Bypass - adverse effects; Gastric Bypass - methods; Gastroenterology and Hepatology; Humans; Incidence; Laparoscopic Roux-en- Y gastric bypass; Laparoscopy - adverse effects; Male; Middle Aged; Nevada - epidemiology; Obesity, Morbid - surgery; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prospective Studies; Stapled anastomosis; Stenosis; Surgery; Surgical Staplers - adverse effects; Suture Techniques - adverse effects; Suture Techniques - instrumentation; Treatment Failure; Nevada; Stenosis; Stapled anastomosis; Laparoscopic Roux-en- Y gastric bypass; Endoscopic dilation
• ISSN: 1550-7289; 1878-7533
• DOI: 10.1016/j.soard.2006.11.014

Abstract Background Laparoscopic Roux-en- Y gastric bypass is the most common bariatric procedure performed in the United States today. The most common early complication after laparoscopic Roux-en- Y is stenosis. No randomized studies have compared the effect of the different staplers on the incidence of stenosis or on long-term weight loss. We compared the anastomoses performed with the two sizes of circular stapler in common use. Methods A total of 200 patients were randomized to undergo 21-mm (n = 100) or 25-mm (n = 100) circular stapled gastroenterostomy after induction of anesthesia. No other differences were allowed in the operative technique. Stenosis was defined as patient complaints of dysphagia leading to endoscopy within 10 weeks of surgery, in which a 9-mm diameter endoscope would not pass through the gastroenterostomy without dilation. Results Of the 200 patients, 19 patients in the 21-mm group and 8 in the 25-mm group underwent endoscopy for symptoms ( P = 0.027). Of the 19 and 8 patients, 17 and 7, respectively, had measurable stenosis at endoscopy ( p = 0.035). Patients with a 21-mm anastomosis developed symptoms an average of 4.8 ± 1.2 weeks after surgery, and those with a 25-mm anastomosis developed symptoms an average of 8.9 ± 3.8 weeks postoperatively ( P <0.001). Conclusions We found a significant difference in the stenosis rate between the 21-mm and 25-mm circular stapled anastomoses in laparoscopic Roux-en- Y gastric bypass. The 21-mm staplers led to significantly more endoscopies than did the 25-mm staplers. Symptoms leading to endoscopy occurred significantly later with use of a 25-mm stapler than after a 21-mm stapler.