Abstract
BACKGROUND
Laparoscopic Roux-en-Y gastric bypass is the most common bariatric procedure performed in the United States today. The most common early complication after laparoscopic Roux-en-Y is stenosis. No randomized studies have compared the effect of the different staplers on the incidence of stenosis or on long-term weight loss. We compared the anastomoses performed with the two sizes of circular stapler in common use.
METHODS
A total of 200 patients were randomized to undergo 21-mm (n = 100) or 25-mm (n = 100) circular stapled gastroenterostomy after induction of anesthesia. No other differences were allowed in the operative technique. Stenosis was defined as patient complaints of dysphagia leading to endoscopy within 10 weeks of surgery, in which a 9-mm diameter endoscope would not pass through the gastroenterostomy without dilation.
RESULTS
Of the 200 patients, 19 patients in the 21-mm group and 8 in the 25-mm group underwent endoscopy for symptoms (P = 0.027). Of the 19 and 8 patients, 17 and 7, respectively, had measurable stenosis at endoscopy (p = 0.035). Patients with a 21-mm anastomosis developed symptoms an average of 4.8 +/- 1.2 weeks after surgery, and those with a 25-mm anastomosis developed symptoms an average of 8.9 +/- 3.8 weeks postoperatively (P <0.001).
CONCLUSIONS
We found a significant difference in the stenosis rate between the 21-mm and 25-mm circular stapled anastomoses in laparoscopic Roux-en-Y gastric bypass. The 21-mm staplers led to significantly more endoscopies than did the 25-mm staplers. Symptoms leading to endoscopy occurred significantly later with use of a 25-mm stapler than after a 21-mm stapler.
TY - JOUR
T1 - Incidence of gastroenterostomy stenosis in laparoscopic Roux-en-Y gastric bypass using 21- or 25-mm circular stapler: a randomized prospective blinded study.
AU - Fisher,Barry L,
AU - Atkinson,James D,
AU - Cottam,Daniel,
Y1 - 2007/02/27/
PY - 2006/05/26/received
PY - 2006/11/21/revised
PY - 2006/11/30/accepted
PY - 2007/3/3/pubmed
PY - 2007/6/1/medline
PY - 2007/3/3/entrez
SP - 176
EP - 9
JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
JO - Surg Obes Relat Dis
VL - 3
IS - 2
N2 - BACKGROUND: Laparoscopic Roux-en-Y gastric bypass is the most common bariatric procedure performed in the United States today. The most common early complication after laparoscopic Roux-en-Y is stenosis. No randomized studies have compared the effect of the different staplers on the incidence of stenosis or on long-term weight loss. We compared the anastomoses performed with the two sizes of circular stapler in common use. METHODS: A total of 200 patients were randomized to undergo 21-mm (n = 100) or 25-mm (n = 100) circular stapled gastroenterostomy after induction of anesthesia. No other differences were allowed in the operative technique. Stenosis was defined as patient complaints of dysphagia leading to endoscopy within 10 weeks of surgery, in which a 9-mm diameter endoscope would not pass through the gastroenterostomy without dilation. RESULTS: Of the 200 patients, 19 patients in the 21-mm group and 8 in the 25-mm group underwent endoscopy for symptoms (P = 0.027). Of the 19 and 8 patients, 17 and 7, respectively, had measurable stenosis at endoscopy (p = 0.035). Patients with a 21-mm anastomosis developed symptoms an average of 4.8 +/- 1.2 weeks after surgery, and those with a 25-mm anastomosis developed symptoms an average of 8.9 +/- 3.8 weeks postoperatively (P <0.001). CONCLUSIONS: We found a significant difference in the stenosis rate between the 21-mm and 25-mm circular stapled anastomoses in laparoscopic Roux-en-Y gastric bypass. The 21-mm staplers led to significantly more endoscopies than did the 25-mm staplers. Symptoms leading to endoscopy occurred significantly later with use of a 25-mm stapler than after a 21-mm stapler.
SN - 1550-7289
UR - https://www.unboundmedicine.com/medline/citation/17331806/Incidence_of_gastroenterostomy_stenosis_in_laparoscopic_Roux_en_Y_gastric_bypass_using_21__or_25_mm_circular_stapler:_a_randomized_prospective_blinded_study_
L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(06)01041-0
DB - PRIME
DP - Unbound Medicine
ER -
