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Transition from a circular to a linear stapling protocol in laparoscopic Roux-en-Y gastric bypass surgery and its impact on quality of life: a 5-year outcome study

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Abstract

Purpose

Surgical technique in bariatric surgery has been refined over the past decades. This study analysed the effect of changing the stapling protocol on the quality of life (QoL) at a midterm follow-up.

Methods

The retrospective cohort study included patients undergoing Roux-en-Y gastric bypass between June 2012 and March 2016. Patients were stratified into the circular stapling protocol (CSP, n = 117) or the linear stapling protocol (LSP, n = 118). QoL was quantified by the Moorehead score at 12, 24 and 60 months. Multivariate testing was used to identify confounders.

Results

The age was 42.8 ± 11.5 years and the body mass index (BMI) was 43.8 ± 6.2 kg/m2, with no baseline intergroup differences. Overall baseline Moorehead score was 0.42 ± 1.1 and improved in both groups after 12 months (1.97 ± 0.74, p < 0.001), 24 months (1.86 ± 0.79, p < 0.001) and 60 months (1.71 ± 0.9, p < 0.001). LSP was associated with improved Moorehead score after 60 months (odds ratio [OR] 1.251, 95% confidence interval [CI] 1.06–1.48, p = 0.010). Overall, a drop of mean BMI occurred and this effect lasted throughout the observation period (− 12.48 kg/m2, p < 0.001). More profound BMI reduction was further positively associated with Moorehead scores after 24 and after 60 months (OR 0.97, p = 0.028; OR 0.96, p = 0.007). Complications, rehospitalisations and reoperations were more frequent in the CSP group (50% vs 23.7%, p < 0.001; 39.7% vs 22.9%, p = 0.009; 37.1% vs 18.6%, p = 0.003).

Conclusion

The CSP and LSP achieve a long-lasting increase in QoL, although the LSP is associated with fewer complications, persistent weight loss and improved Moorehead score. Therefore, the LSP might be considered the favourable protocol in Roux-en-Y gastric bypass.

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References

  1. World Health Organization (2021) Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed 27 March 2022

  2. Bundesamt für Gesundheit (2021) Übergewicht und Adipositas. https://www.bag.admin.ch/bag/de/home/gesund-leben/gesundheitsfoerderung-und-praevention/koerpergewicht/uebergewicht-und-adipositas.html. Accessed 27 March 2022

  3. Haslam DW, James WPT (2005) Obesity. Lancet 366:1197–1209. https://doi.org/10.1016/S0140-6736(05)67483-1

    Article  Google Scholar 

  4. Mingrone G, Panunzi S, De Gaetano A et al (2015) Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 386:964–973. https://doi.org/10.1016/S0140-6736(15)00075-6

    Article  Google Scholar 

  5. Adams TD, Gress RE, Smith SC et al (2007) Long-term mortality after gastric bypass surgery. N Engl J Med 357:753–761. https://doi.org/10.1056/NEJMoa066603

    Article  CAS  Google Scholar 

  6. Sjöström L, Narbro K, Sjöström CD et al (2007) Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 357:741–752. https://doi.org/10.1056/NEJMoa066254

    Article  Google Scholar 

  7. Picot J, Jones J, Colquitt JL et al (2009) The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess 13:1–190, 215–357, iii–iv. https://doi.org/10.3310/hta13410

  8. Sjöström L, Lindroos A-K, Peltonen M et al (2004) Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 351:2683–2693. https://doi.org/10.1056/NEJMoa035622

    Article  Google Scholar 

  9. Edholm D, Sundbom M (2015) Comparison between circular- and linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass–a cohort from the Scandinavian Obesity Registry. Surg Obes Relat Dis 11:1233–1236. https://doi.org/10.1016/j.soard.2015.03.010

    Article  Google Scholar 

  10. Schneider R, Gass J-M, Kern B et al (2016) 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. Langenbecks Arch Surg 401:307–313. https://doi.org/10.1007/s00423-016-1397-0

    Article  Google Scholar 

  11. Vines L, Frick T, Aczél S et al (2017) Linear stapled gastrojejunostomy results in fewer strictures compared to circular stapled gastrojejunostomy in laparoscopic gastric bypass surgery. Langenbecks Arch Surg 402:911–916. https://doi.org/10.1007/s00423-017-1598-1

    Article  Google Scholar 

  12. Barr AC, Lak KL, Helm MC et al (2019) Linear vs. circular-stapled gastrojejunostomy in Roux-en-Y gastric bypass. Surg Endosc 33:4098–4101. https://doi.org/10.1007/s00464-019-06712-2

    Article  Google Scholar 

  13. Edholm D (2019) Systematic review and meta-analysis of circular- and linear-stapled gastro-jejunostomy in laparoscopic Roux-en-Y gastric bypass. Obes Surg 29:1946–1953. https://doi.org/10.1007/s11695-01903803-w

    Article  Google Scholar 

  14. von Elm E, Altman DG, Egger M et al (2014) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 12:1495–1499. https://doi.org/10.1016/j.ijsu.2014.07.013

    Article  Google Scholar 

  15. Moorehead MK, Ardelt-Gattinger E, Lechner H, Oria HE (2003) The validation of the Moorehead-Ardelt Quality of Life Questionnaire II. Obes Surg 13:684–692. https://doi.org/10.1381/096089203322509237

    Article  Google Scholar 

  16. Wittgrove AC, Clark GW, Tremblay LJ (1994) Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg 4:353–357. https://doi.org/10.1381/096089294765558331

    Article  CAS  Google Scholar 

  17. Lönroth H, Dalenbäck J, Haglind E, Lundell L (1996) Laparoscopic gastric bypass. Another option in bariatric surgery. Surg Endosc 10:636–638

    Article  Google Scholar 

  18. Janik MR, Rogula T, Bielecka I et al (2016) Quality of life and bariatric surgery: cross-sectional study and analysis of factors influencing outcome. Obes Surg 26:2849–2855. https://doi.org/10.1007/s11695-016-2220-2

    Article  Google Scholar 

  19. Zhang Y, Zhao H, Cao Z et al (2014) A randomized clinical trial of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy for the treatment of morbid obesity in China: a 5-year outcome. Obes Surg 24:1617–1624. https://doi.org/10.1007/s11695-014-1258-2

    Article  Google Scholar 

  20. Nielsen HJ, Nedrebø BG, Fosså A et al (2022) Seven-year trajectories of body weight, quality of life and comorbidities following Roux-en-Y gastric bypass and sleeve gastrectomy. Int J Obes (Lond) 46:739–749. https://doi.org/10.1038/s41366-021-01028-5

    Article  CAS  Google Scholar 

  21. Salminen P, Helmiö M, Ovaska J et al (2018) Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA 319(3):241–254. https://doi.org/10.1001/jama.2017.20313

    Article  Google Scholar 

  22. Abu Dayyeh BK, Lautz DB, Thompson CC (2011) Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. Clin Gastroenterol Hepatol 9:228–233. https://doi.org/10.1016/j.cgh.2010.11.004

    Article  Google Scholar 

  23. Kalarchian MA, Marcus MD, Wilson GT et al (2002) Binge eating among gastric bypass patients at long-term follow-up. Obes Surg 12:270–275. https://doi.org/10.1381/096089202762552494

    Article  Google Scholar 

  24. Sima E, Hedberg J, Sundbom M (2016) Gastrointestinal symptoms, weight loss and patient satisfaction 5 years after gastric bypass: a study of three techniques for the gastrojejunal anastomosis. Surg Endosc 30:1553–1558. https://doi.org/10.1007/s00464-015-4374-8

    Article  CAS  Google Scholar 

  25. Stenberg E, Näslund I, Szabo E, Ottosson J (2018) Impact of mesenteric defect closure technique on complications after gastric bypass. Langenbecks Arch Surg 403:481–486. https://doi.org/10.1007/s00423-018-1684-z

    Article  Google Scholar 

  26. Folope V, Hellot M-F, Kuhn J-M et al (2008) Weight loss and quality of life after bariatric surgery: a study of 200 patients after vertical gastroplasty or adjustable gastric banding. Eur J Clin Nutr 62:1022–1030. https://doi.org/10.1038/sj.ejcn.1602808

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland

    Hugo Teixeira, Sascha Halvachizadeh, Michel P. J. Teuben, Pascal Probst & Markus K. Muller

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  1. Hugo Teixeira
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  2. Sascha Halvachizadeh
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Contributions

H.T. planned the study, collected the data, performed and interpreted formal analyses and wrote the original article. S.H. interpreted and analysed the data and critically reviewed the article. M.P.J.T. interpreted the data and critically reviewed the article. P.P. interpreted the data and critically reviewed the article. M.K.M. planned and supervised the study, collected the data, interpreted the analyses and critically reviewed the article.

Corresponding author

Correspondence to Hugo Teixeira.

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Ethics approval and consent to participate

This retrospective chart review study involving human participants was performed in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This study was approved by the local institutional review board (Project-ID 2019–00488, EKOS 19/040). Informed consent was obtained from all participants included in the study.

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The authors declare no competing interests.

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Teixeira, H., Halvachizadeh, S., Teuben, M.P.J. et al. Transition from a circular to a linear stapling protocol in laparoscopic Roux-en-Y gastric bypass surgery and its impact on quality of life: a 5-year outcome study. Langenbecks Arch Surg 407, 3341–3348 (2022). https://doi.org/10.1007/s00423-022-02635-0

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