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

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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.

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Authors and Affiliations

  1. Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, K4/762 Clinical Science Center, Madison, WI, 53792-7375, USA

    Jon Charles Gould, Michael Garren, Valerie Boll & James Starling

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  1. Jon Charles Gould
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  2. Michael Garren
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  3. Valerie Boll
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  4. James Starling
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Correspondence to Jon Charles Gould.

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Gould, J.C., Garren, M., Boll, V. et al. 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, 1017–1020 (2006). https://doi.org/10.1007/s00464-005-0207-5

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  • DOI: https://doi.org/10.1007/s00464-005-0207-5

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