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Obesity Surgery

, Volume 24, Issue 9, pp 1425–1429 | Cite as

Comparison of Gastrojejunal Anastomosis Techniques in Laparoscopic Roux-en-Y Gastric Bypass: Gastrojejunal Stricture Rate and Effect on Subsequent Weight Loss

  • Sangoh LeeEmail author
  • Andrew R. Davies
  • Sameer Bahal
  • Daniel M. Cocker
  • Gianluca Bonanomi
  • Jeremy Thompson
  • Evangelos Efthimiou
Original Contributions

Abstract

Background

Different gastrojejunal anastomotic (GJA) techniques have been described in laparoscopic Roux-en-Y gastric bypass (LRYGB). There is conflicting data on whether one technique is superior to the other. We aimed to compare hand-sewn (HSA), circular-stapled (CSA) and linear-stapled (LSA) anastomotic techniques in terms of stricture rates and their impact on subsequent weight loss.

Methods

A prospectively collected database was used to identify patients undergoing LRYGB surgery between March 2005 and May 2012. Anastomotic technique (HSA, CSA, LSA) was performed according to individual surgeon preference. The database recorded patient demographics, relevant comorbidities and the type of GJA performed. Serial weight measurements and percentage excess weight loss (%EWL) were available at defined follow-up intervals.

Results

Included in the data were 426 patients, divided between HSA (n = 174, 40.8 %), CSA (n = 110, 25.8 %) and LSA (n = 142, 33.3 %). There was no significant difference in the stricture rates (HSA n = 17, 9.72 %; CSA n = 9, 8.18 %; LSA n = 8, 5.63 %; p = 0.4006). Weight loss was similar between the three techniques (HSA, CSA and LSA) at 3 months (40.6 % ± 16.2 % vs 35.92 % ± 21.42 % vs 48.21 % ± 14.79 %; p = 0.0821), 6 months (61.48 % ± 23.94 % vs 58.16 % ± 27.31 % vs 60.18 % ± 22.26 %; p = 0.2296), 12 months (72.94 % ± 19.93 % vs 69.72 ± 21.42 % vs 66.05 % ± 17.75 %; p = 0.0617) and 24 months (73.29 % ± 22.31 % vs 68.75 % ± 24.71 % vs 69.40 % ± 23.10 %; p = 0.7242), respectively.

The stricture group lost significantly greater weight (%EWL) within the first 3 months compared to the non-stricture group (45.39 % ± 16.82 % vs 39.22 % ± 21.93 %; p = 0.0340); however, this difference had resolved at 6 months (61.29 % ± 18.50 % vs 59.79 % ± 23.03 %; p = 0.8802) and 12 months (71.59 % ± 18.67 % vs 68.69 % ± 22.19 %; p = 0.5970).

Conclusions

There was no significant difference in the rate of strictures between the three techniques, although the linear technique appears to have the lowest requirement for post-operative dilatation. The re-intervention rate will, in part, be dictated by the threshold for endoscopy, which will vary between units. Weight loss was similar between the three anastomotic techniques. Surgeons should use techniques that they are most familiar with, as stricture and weight loss rates are not significantly different.

Keywords

LRYGB Gastrojejunal anastomosis Stricture rate Weight loss 

Notes

Sources of Funding

Department of Surgery, Chelsea and Westminster Hospital NHS Trust

Conflict of Interest

None of the authors have a potential conflict of interest.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sangoh Lee
    • 1
    Email author
  • Andrew R. Davies
    • 1
  • Sameer Bahal
    • 1
  • Daniel M. Cocker
    • 1
  • Gianluca Bonanomi
    • 1
  • Jeremy Thompson
    • 1
  • Evangelos Efthimiou
    • 1
  1. 1.Bariatric and Metabolic Surgery UnitChelsea and Westminster Hospital NHS TrustLondonUK

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