Gastroenteroanastomosis with a linear or circular stapler? Is there really a preference for laparoscopic gastric bypass?

Abstract

AbstractBACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective and well-accepted procedure for the treatment of morbid obesity but has complications such as stenosis of the gastroenteroanastomosis (GE), GE leak, surgical site infection, and stapling malfunction. Some aspects related to the surgical technique have been described in the literature as the cause of these complications, especially stenosis of the gastrojejunal anastomosis. This study evaluated the efficiency of weight loss and the incidence of short- and mid-term postoperative complications in patients undergoing LRYGB in which anastomosis was performed using a linear stapler (LSA) or a circular stapler (CSA). METHODS: Prospective observational study conducted between April 2016 and March 2019. The data were extracted from a database that includes patients undergoing LRYGB performed by the same surgeon and at the same institution. Data were collected on gastroenteroanastomosis technique, postoperative complications, and excess body weight loss at 30, 180, and 360 days. RESULTS: Data from 457 patients were analyzed, of which 216 patients were in the LSA group and 241, in the CSA group. There was no significant difference between the groups regarding initial BMI, age, gender, and comorbidities. Operative time, hospital stay, and excess body weight loss during the 12-month follow-up period were also similar in the two groups. There were four cases (1.7%) of GE stenosis in the CSA group and only one case (0.5%) in the LSA group, which were treated with one successful endoscopic dilatation. Stapler malfunction occurred in both groups: CSA (0.4%) and LSA (0.5%), and was repaired with intraoperative manual suture, and a GE leak developed (0.4%) only in the CSA group, which was successfully treated conservatively. Surgical site infection was found in five patients in the CSA group (2.1%) and two patients in the LSA group (0.9%). No statistical difference was found between the two groups in any of the variables analyzed (p>0.05). CONCLUSIONS: Both stapling techniques resulted in a similar loss of excess body weight during the follow-up period. Although the LSA group had fewer total complications, these were not statistically significant, which substantiates the fact that both techniques are safe and feasible, provided they are performed by a surgeon with a long learning curve in laparoscopic bariatric surgery.