The impact of circular stapler diameter on the incidence of gastrojejunostomy stenosis and weight loss following laparoscopic Roux-en-Y gastric bypass

  • Jon Charles Gould
  • Michael Garren
  • Valerie Boll
  • James Starling
Article

DOI: 10.1007/s00464-005-0207-5

Cite this article as:
Gould, J.C., Garren, M., Boll, V. et al. Surg Endosc (2006) 20: 1017. doi:10.1007/s00464-005-0207-5

Abstract

Background

Gastrojejunostomy stenosis after laparoscopic Roux-en-Y gastric bypass is a common occurrence. The incidence varies widely among reported series. We evaluated the impact of circular stapler size on the rate of stenosis and weight loss.

Methods

Our initial technique utilized a 21-mm circular stapler to construct the gastrojejunostomy. We switched to a 25-mm stapler after a large preliminary experience. Stenosis was confirmed by endoscopy in patients complaining of the inability to eat or excessive vomiting, and was defined as a gastrojejunostomy diameter less than that of a therapeutic endoscope (11-mm).

Results

Stenosis occurred in 23 of 145 patients (15.9%) with a 21-mm gastrojejunostomy. Five of 81 patients with a 25-mm circular stapled anastomosis have developed a stenosis (6.2%, p = 0.03). Weight loss was similar for each sized stapler at 6 and 12 months.

Conclusions

The use of a 25-mm circular stapler in laparoscopic gastric bypass is preferable to a 21-mm stapler. The larger stapler is associated with a significantly decreased incidence of gastrojejunostomy stenosis without compromising early weight loss.

Keywords

Surgical < Technical Obesity Therapeutic/Palliation < Endoscopy Bariatric 

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Jon Charles Gould
    • 1
  • Michael Garren
    • 1
  • Valerie Boll
    • 1
  • James Starling
    • 1
  1. 1.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA