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Incidence of gastroenterostomy stenosis in laparoscopic Roux-en-Y gastric bypass using 21- or 25-mm circular stapler: a randomized prospective blinded study.
Surg Obes Relat Dis. 2007 Mar-Apr; 3(2):176-9.SO

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.

Authors+Show Affiliations

Surgical Weight Control Center, Las Vegas, Nevada, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

17331806

Citation

Fisher, Barry L., et al. "Incidence of Gastroenterostomy Stenosis in Laparoscopic Roux-en-Y Gastric Bypass Using 21- or 25-mm Circular Stapler: a Randomized Prospective Blinded Study." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 3, no. 2, 2007, pp. 176-9.
Fisher BL, Atkinson JD, Cottam D. Incidence of gastroenterostomy stenosis in laparoscopic Roux-en-Y gastric bypass using 21- or 25-mm circular stapler: a randomized prospective blinded study. Surg Obes Relat Dis. 2007;3(2):176-9.
Fisher, B. L., Atkinson, J. D., & Cottam, D. (2007). Incidence of gastroenterostomy stenosis in laparoscopic Roux-en-Y gastric bypass using 21- or 25-mm circular stapler: a randomized prospective blinded study. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 3(2), 176-9.
Fisher BL, Atkinson JD, Cottam D. Incidence of Gastroenterostomy Stenosis in Laparoscopic Roux-en-Y Gastric Bypass Using 21- or 25-mm Circular Stapler: a Randomized Prospective Blinded Study. Surg Obes Relat Dis. 2007 Mar-Apr;3(2):176-9. PubMed PMID: 17331806.
* Article titles in AMA citation format should be in sentence-case
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 -