Smaller staple height for circular stapled gastrojejunostomy in laparoscopic gastric bypass: Early results in 1,074 morbidly obese patients

Nasser Sakran, Ahmad Assalia, Ahud Sternberg, Yoram Kluger, Anton Troitsa, Eran Brauner, Sebastiaan Van Cauwenberge, Marieke De Visschere, Bruno Dillemans

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

Background: Anastomotic leaks, stenosis, and bleeding from the gastrojejunal anastomosis (GJA) after gastric bypass may carry high morbidity and mortality. To date, the standard operation with the circular stapler (CS) used the 25 mm with a staple height of 4.8 mm. We present herein our experience with the 3.5-mm staple height. Methods: A total of 1,074 morbidly obese patients who underwent fully stapled laparoscopic Roux-en-Y Gastric Bypass over a period of 18 months were included in the study. Mean body mass index was 41.9 (range 28.6-70.7). Mean age was 40.9 years (range 15-74 years). Mean operating time was 73 min (range 43-210 min) and the mean length of stay was 4.2 days (range 1-25 days). The 30-day complication rate associated with GJA was prospectively analyzed. Results: Twenty patients (1.86%) developed postoperative bleeding. Four developed GJA bleeding (0.37%). One leak was recorded from the vertical staple line of the gastric pouch, but no leaks from the GJA were seen. Conversion to open approach was required in two patients (0.18%). Reoperation and readmission rates were 1.7% and 1.8%, respectively. Perioperative complications were observed in 34 patients (3.1%). One case of clinical GJA stenosis was detected in a mean follow-up of 10.5 months (range 5-20 months). There was no mortality in our series. Conclusion: Compared to our previous experience with 4.8 mm CS, creating the GJA using a smaller staple height significantly reduced the bleeding rate and seems to be a safe technique that potentially reduces other complications related to the GJA as reported in the literature.

Original languageEnglish
Pages (from-to)238-243
Number of pages6
JournalObesity Surgery
Volume21
Issue number2
DOIs
StatePublished - Feb 2011
Externally publishedYes

Keywords

  • Circular stapler
  • Complications
  • Gastro-jejunal anastomosis
  • Morbid obesity
  • Roux-en-Y gastric bypass

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