Comparison of stricture rates using three different gastrojejunostomy anastomotic techniques in laparoscopic Roux-en-Y gastric bypass

Abstract

Introduction

No single gastrojejunostomy anastomosis technique (GJA) in Laparoscopic Roux-en-Y gastric bypass (LRYGB) is currently preferred over another. Bendewald et al. confirmed that there was no difference in anastomotic stricture rates when comparing hand-sewn (HS), linear-stapled (LS), and circular-stapled (CS) GJA techniques. We present and analyze our own institutional data to readdress stricture rates.

Methods

From January 2010 to January 2013, 860 consecutive patients underwent LRYGB using HS, LS, and CS anastomotic techniques at a single institution. All patients in this study were followed to see if they had a complication of a stricture within this time period. Hospital records were retrospectively reviewed and those who had stricture complications shown on endoscopy requiring intervention were compiled and compared using univariate analysis.

Results

Patient demographics did not differ substantially between the three groups. The most common technique employed was LS (n = 429, 49.8 %), followed by CS (n = 254, 29.5 %) and HS (n = 177, 20.6 %), respectively. Using multivariate analysis, there was a significant difference in the rate of strictures between the anastomotic techniques (LS 4.42 %, HS 2.82 %, CS 1.18 %, p = 0.0163).

Conclusions

Our data show that the discussion of which anastomotic technique is superior should be reopened given the statistically significant low rate of strictures in patients who underwent LRYGB with a CS anastomosis in comparison with LS and HS anastomoses.