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Complications at gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass: comparison between 21- and 25-mm circular staplers.
Surg Obes Relat Dis. 2007 Sep-Oct; 3(5):508-14.SO

Abstract

BACKGROUND

Complications involving the gastrojejunostomy (GJ) after laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity frequently result in hospital readmission and additional procedures. The purpose of this study was to compare the complication rate of GJ performed with the 21- and 25-mm circular staplers.

METHODS

We retrospectively reviewed the incidence of stricture, bleeding, ulcer, and leak at the GJ in 438 consecutive patients who had undergone LRYGB.

RESULTS

The GJ was performed using the 25-mm stapler in 374 patients and the 21-mm stapler in 64 patients. Of the 50 anastomotic complications, 11 (17.2%) occurred with the 21-mm stapler, including 6 strictures (9.4%), 4 ulcers (6.3%), and 1 leak (1.6%), and 39 (10.4%) with the 25-mm stapler, including 11 strictures (2.9%), 6 acute bleeding episodes (1.6%), 19 ulcers (5.4%), and 4 leaks (1.1%). Rehospitalization was required in 9 patients (47%) with a pure stricture and 17 (74%) with ulcers. The incidence of pure stricture was significantly greater in the GJ performed with the 21-mm than with the 25-mm stapler (P = .026, Fisher's exact test). No difference was found in the rate of acute bleeding, leak, or ulcer between the 2 groups. All strictures resolved with balloon dilation. Four patients with stenotic ulcers that failed to respond to dilation and medications required operative revision. No difference was found in postoperative weight loss between the 2 groups.

CONCLUSION

Anastomotic complications were recognized in 50 (11.4%) of 438 patients who had undergone LRYGB in which the GJ was performed using circular staplers, including 11 (17.2%) with the 21-mm and 39 (10.2%) with the 25-mm stapler. The rate of anastomotic stricture was significantly lower using the 25-mm circular stapler.

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Authors+Show Affiliations

Suggs WJ
Department of Surgery, University Medical Center at Princeton, Princeton, New Jersey 08852, USA.
Kouli W
No affiliation info available
Lupovici M
No affiliation info available
Chau WY
No affiliation info available
Brolin RE
No affiliation info available

MeSH

Anastomosis, Roux-en-YCatheterizationConstriction, PathologicEquipment DesignFemaleFollow-Up StudiesGastric BypassGastroenterostomyGastrointestinal DiseasesGastrointestinal HemorrhageHumansIncidenceJejunostomyMiddle AgedObesity, MorbidPatient ReadmissionReoperationRetrospective StudiesSurgical StaplersUlcer

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17686661

Citation

Suggs, W Jay, et al. "Complications at Gastrojejunostomy After Laparoscopic Roux-en-Y Gastric Bypass: Comparison Between 21- and 25-mm Circular Staplers." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 3, no. 5, 2007, pp. 508-14.
Suggs WJ, Kouli W, Lupovici M, et al. Complications at gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass: comparison between 21- and 25-mm circular staplers. Surg Obes Relat Dis. 2007;3(5):508-14.
Suggs, W. J., Kouli, W., Lupovici, M., Chau, W. Y., & Brolin, R. E. (2007). Complications at gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass: comparison between 21- and 25-mm circular staplers. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 3(5), 508-14.
Suggs WJ, et al. Complications at Gastrojejunostomy After Laparoscopic Roux-en-Y Gastric Bypass: Comparison Between 21- and 25-mm Circular Staplers. Surg Obes Relat Dis. 2007 Sep-Oct;3(5):508-14. PubMed PMID: 17686661.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Complications at gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass: comparison between 21- and 25-mm circular staplers. AU - Suggs,W Jay, AU - Kouli,Wael, AU - Lupovici,Michael, AU - Chau,Wai Yip, AU - Brolin,Robert E, Y1 - 2007/08/08/ PY - 2007/03/07/received PY - 2007/04/13/revised PY - 2007/05/01/accepted PY - 2007/8/10/pubmed PY - 2008/1/9/medline PY - 2007/8/10/entrez SP - 508 EP - 14 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 3 IS - 5 N2 - BACKGROUND: Complications involving the gastrojejunostomy (GJ) after laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity frequently result in hospital readmission and additional procedures. The purpose of this study was to compare the complication rate of GJ performed with the 21- and 25-mm circular staplers. METHODS: We retrospectively reviewed the incidence of stricture, bleeding, ulcer, and leak at the GJ in 438 consecutive patients who had undergone LRYGB. RESULTS: The GJ was performed using the 25-mm stapler in 374 patients and the 21-mm stapler in 64 patients. Of the 50 anastomotic complications, 11 (17.2%) occurred with the 21-mm stapler, including 6 strictures (9.4%), 4 ulcers (6.3%), and 1 leak (1.6%), and 39 (10.4%) with the 25-mm stapler, including 11 strictures (2.9%), 6 acute bleeding episodes (1.6%), 19 ulcers (5.4%), and 4 leaks (1.1%). Rehospitalization was required in 9 patients (47%) with a pure stricture and 17 (74%) with ulcers. The incidence of pure stricture was significantly greater in the GJ performed with the 21-mm than with the 25-mm stapler (P = .026, Fisher's exact test). No difference was found in the rate of acute bleeding, leak, or ulcer between the 2 groups. All strictures resolved with balloon dilation. Four patients with stenotic ulcers that failed to respond to dilation and medications required operative revision. No difference was found in postoperative weight loss between the 2 groups. CONCLUSION: Anastomotic complications were recognized in 50 (11.4%) of 438 patients who had undergone LRYGB in which the GJ was performed using circular staplers, including 11 (17.2%) with the 21-mm and 39 (10.2%) with the 25-mm stapler. The rate of anastomotic stricture was significantly lower using the 25-mm circular stapler. SN - 1550-7289 UR - https://www.unboundmedicine.com/medline/citation/17686661/Complications_at_gastrojejunostomy_after_laparoscopic_Roux_en_Y_gastric_bypass:_comparison_between_21__and_25_mm_circular_staplers_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(07)00449-2 DB - PRIME DP - Unbound Medicine ER -