Surgical Endoscopy

, Volume 25, Issue 7, pp 2164–2167 | Cite as

Impact of gastrojejunostomy diameter on long-term weight loss following laparoscopic gastric bypass: a follow-up study

Article

Abstract

Background

Stenosis of the gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass is a common occurrence. We have previously presented data demonstrating that the use of a 25-mm circular stapler results in a decreased incidence of stenosis compared to the results of a 21-mm circular stapler (6.2 vs. 15.9%, P = 0.03). One potential drawback of the larger-diameter stapler is the possibility for impaired long-term weight loss due to decreased restriction. We sought to determine the impact of circular stapler diameter on excess weight loss up to 5 years after surgery.

Methods

Our initial technique for creating the gastrojejunostomy after laparoscopic gastric bypass involved the transgastric passage of a 21-mm circular stapler anvil (group 1). After a large initial experience, we switched to a 25-mm circular stapler (group 2). Follow-up data were entered prospectively into a computer database. Weight loss was recorded as percent of excess weight lost. Only patients with follow-up beyond 3 years postoperatively were eligible for inclusion.

Results

Group 1 consisted of 145 consecutive patients and group 2 consisted of 116 consecutive patients. There was no significant difference in weight loss between the groups at 3 (66.1 vs. 65.2%, P = 0.76, n = 134), 4 (66.4 vs. 58.6%, P = 0.1, n = 66), and 5 years after gastric bypass (62.7 vs. 57.5%, P = 0.24, n = 75).

Conclusions

The use of a 25-mm circular stapler in laparoscopic gastric bypass operations instead of a 21-mm stapler does not result in significantly different long-term weight loss. The 25-mm stapler is preferred with our technique.

Keywords

Gastrojejunostomy Stenosis Laparoscopic gastric bypass Weight loss 

Notes

Disclosures

Dr. Gould is a speaker for Covidien for which he receives an honorarium. Drs. Smith and Garren have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Buchwald H, Oien DM (2009) Metabolic/bariatric surgery worldwide 2008. Obes Surg 19:1605–1611PubMedCrossRefGoogle Scholar
  2. 2.
    Gould JC, Garren M, Boll V, Starling J (2006) The impact of circular stapler diameter on the incidence of gastrojejunostomy stenosis and weight loss following laparoscopic Roux-en-Y gastric bypass. Surg Endosc 20:1017–1020PubMedCrossRefGoogle Scholar
  3. 3.
    Catalano MF, Rudic G, Anderson AJ, Chua TY (2007) Weight gain after bariatric surgery as a result of a large gastric stoma: endotherapy with sodium morrhuate may prevent the need for surgical revision. Gastrointest Endosc 66:240–245PubMedCrossRefGoogle Scholar
  4. 4.
    Loewen M, Barba C (2008) Endoscopic sclerotherapy for dilated gastrojejunostomy of failed gastric bypass. Surg Obes Relat Dis 4:539–542; discussion 542–543Google Scholar
  5. 5.
    Gould JC, Garren MJ, Starling JR (2004) Lessons learned from the first 100 cases in a new minimally invasive bariatric surgery program. Obes Surg 14:618–625PubMedCrossRefGoogle Scholar
  6. 6.
    Higa KD, Ho T, Boone KB (2001) Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Tech A 11:377–382PubMedCrossRefGoogle Scholar
  7. 7.
    Wittgrove AC, Clark GW (2000) Laparoscopic gastric bypass, Roux-en-Y- 500 patients: technique and results, with 3–60 month follow-up. Obes Surg 10:233–239PubMedCrossRefGoogle Scholar
  8. 8.
    Nguyen NT, Stevens CM, Wolfe BM (2003) Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass. J Gastrointest Surg 7:997–1003; discussion 1003Google Scholar
  9. 9.
    Csendes A, Burgos AM, Burdiles P (2009) Incidence of anastomotic strictures after gastric bypass: a prospective consecutive routine endoscopic study 1 month and 17 months after surgery in 441 patients with morbid obesity. Obes Surg 19:269–273PubMedCrossRefGoogle Scholar
  10. 10.
    Sczepaniak JP, Owens ML (2009) Results of gastrojejunal anastomotic technique designed to reduce stricture. Surg Obes Relat Dis 5:77–80PubMedCrossRefGoogle Scholar
  11. 11.
    Owens ML, Sczepaniak JP (2009) Size really does matter—role of gastrojejunostomy in postoperative weight loss. Surg Obes Relat Dis 5:357–361PubMedCrossRefGoogle Scholar
  12. 12.
    Stahl RD, Sherer RA, Seevers CE, Johnston D (2000) Comparison of 21 vs. 25 mm gastrojejunostomy in the gastric bypass procedure—early results. Obes Surg 10:540–542PubMedCrossRefGoogle Scholar
  13. 13.
    Cottam DR, Fisher B, Sridhar V, Atkinson J, Dallal R (2009) The effect of stoma size on weight loss after laparoscopic gastric bypass surgery: results of a blinded randomized controlled trial. Obes Surg 19:13–17PubMedCrossRefGoogle Scholar
  14. 14.
    Fisher BL, Atkinson JD, Cottam D (2007) Incidence of gastroenterostomy stenosis in laparoscopic Roux-en-Y gastric bypass using 21- or 25-mm circular stapler: a randomized prospective blinded study. Surg Obes Relat Dis 3:176–179PubMedCrossRefGoogle Scholar
  15. 15.
    Suggs WJ, Kouli W, Lupovici M, Chau WY, Brolin RE (2007) Complications at gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass: comparison between 21- and 25-mm circular staplers. Surg Obes Relat Dis 3:508–514PubMedCrossRefGoogle Scholar
  16. 16.
    Roberts K, Duffy A, Kaufman J, Burrell M, Dziura J, Bell R (2007) Size matters: gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Endosc 21:1397–1402PubMedCrossRefGoogle Scholar
  17. 17.
    Mikami D, Needleman B, Narula V, Durant J, Melvin WS (2010) Natural orifice surgery: initial US experience utilizing the StomaphyX device to reduce gastric pouches after Roux-en-Y gastric bypass. Surg Endosc 24:223–228PubMedCrossRefGoogle Scholar
  18. 18.
    Mullady DK, Lautz DB, Thompson CC (2009) Treatment of weight regain after gastric bypass surgery when using a new endoscopic platform: initial experience and early outcomes (with video). Gastrointest Endosc 70:440–444PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.H4/726 Clinical Science CenterMadisonUSA

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