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Smaller Staple Height for Circular Stapled Gastrojejunostomy in Laparoscopic Gastric Bypass: Early Results in 1,074 Morbidly Obese Patients

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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.

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Conflict of interest

The authors report no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Funding

The authors did not receive any financial or material support for this study.

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Authors and Affiliations

  1. Department of General Surgery A, Hillel Yaffe Medical Center, P.O.Box 169, Hadera, 38100, Israel

    Nasser Sakran, Ahud Sternberg & Anton Troitsa

  2. Department of General Surgery B, Rambam Health Care Campus, Haifa, Israel

    Ahmad Assalia, Yoram Kluger & Eran Brauner

  3. Department of General Surgery, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium

    Sebastiaan Van Cauwenberge, Marieke De Visschere & Bruno Dillemans

  4. Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel

    Nasser Sakran, Ahmad Assalia, Ahud Sternberg, Yoram Kluger, Anton Troitsa & Eran Brauner

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  1. Nasser Sakran
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  2. Ahmad Assalia
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  3. Ahud Sternberg
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Corresponding author

Correspondence to Nasser Sakran.

Additional information

Nasser Sakran and Ahmad Assalia equally contributed to the writing of this manuscript.

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Sakran, N., Assalia, A., Sternberg, A. et al. Smaller Staple Height for Circular Stapled Gastrojejunostomy in Laparoscopic Gastric Bypass: Early Results in 1,074 Morbidly Obese Patients. OBES SURG 21, 238–243 (2011). https://doi.org/10.1007/s11695-010-0308-7

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