Jon Charles Gould1, Michael Garren, Valerie Boll, James Starling. 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. gould@surgery.wisc.edu
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.
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.
Authors: Jon C Gould; Bradley J Needleman; E Christopher Ellison; Peter Muscarella; Carol Schneider; W Scott Melvin Journal: Surgery Date: 2002-10 Impact factor: 3.982
Authors: W J Pories; K G MacDonald; E G Flickinger; G L Dohm; M K Sinha; H A Barakat; H J May; P Khazanie; M S Swanson; E Morgan Journal: Ann Surg Date: 1992-06 Impact factor: 12.969
Authors: Michael L Schwartz; Raymond L Drew; Ryan W Roiger; Scott R Ketover; Marilyn Chazin-Caldie Journal: Obes Surg Date: 2004-04 Impact factor: 4.129
Authors: Austin Cottam; Daniel Cottam; Walter Medlin; Christina Richards; Samuel Cottam; Hinali Zaveri; Amit Surve Journal: Surg Endosc Date: 2015-12-22 Impact factor: 4.584
Authors: Alexander C Barr; Kathleen L Lak; Melissa C Helm; Tammy L Kindel; Rana M Higgins; Jon C Gould Journal: Surg Endosc Date: 2019-02-25 Impact factor: 4.584
Authors: Edward Shang; Till Hasenberg; Richard Magdeburg; Michael Keese; Stefan Post; Rudolf Weiner Journal: Obes Surg Date: 2008-08-30 Impact factor: 4.129
Authors: Frank P Bendewald; Jennifer N Choi; Lorie S Blythe; Don J Selzer; John H Ditslear; Samer G Mattar Journal: Obes Surg Date: 2011-11 Impact factor: 4.129