Calibrated Gastrojejunostomy in Gastric Bypass: It Is a Myth

The tighter the stoma, the greater the loss: A narrower gastrojejunostomy is more beneficial for weight loss following roux-en-Y gastric bypass

The optimal size of Gastrojejunostomy (GJ) in Laparoscopic Roux-EnY Gastric Bypass (LRYGB) for a- preferential weight loss is still unknown. This study aimed to investigate the influence of linear-stapled GJ size in long-term LRYGB weight reduction results. We performed a retrospective analysis of 100 patients who underwent LRYGB surgery between January and July 2021. The patients were divided into two 50-patient groups based on the size of their linear-stapled GJ, either 30 or 45 mm. Their weight loss was observed and compared on day 15, and the following appointments were 1, 3, 6, 9, 12, 18, and 24 months after surgery. After 24 months, the 30-mm group reduced their BMI by an average of 19.23, compared with the 16.43 kg/m2 of the 45-mm group (p < .001). Overall, repeated measures ANOVA showed a beneficial weight loss pattern for the 30-mm group in all four categories (weight, BMI, EWL, and TWL). Upon adjusting for age, biliopancreatic length, alimentary length, sex, history of diabetes, and a history of hypertension in repeated measures ANOVA, this difference remained significantly in favour of the 30-mm GJ. Based on the results of this study, performing a gastrojejunostomy with a 30-mm stapler compared to a 45-mm stapler increases weight loss in LRYGB patients.

Linear and circular stapled gastrojejunal anastomoses in Roux-en-Y gastric bypass: stomal diameter at onset and at long-term follow-up

BACKGROUND

In the laparoscopic Roux-en-Y gastric bypass procedure, the gastrojejunal stoma is constructed with either a circular (CSD) or a linear stapling device (LSD). The diameter of the stoma following stapling with the 21 mm CSD is expected to be approximately 12 mm (diameter of the anvil). Measuring the stoma diameter after linear stapling is a little more complex since the remaining opening in the linear anastomosis is closed by hand. The aim of this prospective randomized study was to follow up on changes in the diameter of gastrojejunal stomata after laparoscopic Roux-en-Y gastric bypass using either a CSD or an LSD between that at construction and at a long-term follow-up of 12-72 months later.

METHODS

Twenty patients were randomly assigned to gastrojejunostomy with either a 21 mm CSD or a 45 mm LSD. Directly after completion of the surgery, the diameter of the gastrojejunal stoma was measured using a Fogarty occlusion catheter and again at follow-up 12-72 months later.

RESULTS

Five patients were lost for follow-up, and 15 patients remained. The mean diameter of the CSD stomata at construction was 19.3 ± 5.3 mm (mean ± SD) and increased to 26.4 ± 6.6 mm at follow-up after a mean of 46 months (P = 0.02). The corresponding figures for the LSD stomata were 26.2 ± 4.1 mm, increasing to 32.7 ± 3.0 mm also after a mean follow-up of 46 months (P = 0.03).

CONCLUSIONS

The mean diameter of the circular stapled gastrojejunostomy stomata at construction was 20 mm, that is, considerably larger than the 12 mm expected. After a mean of 5 years, the mean diameter had increased by 37%. The mean diameter of the linear stapled stomata increased by 25%.

Gastrojejunostomy in Roux-En-Y Gastric Bypass for Morbid Obesity: Linear Stapler Length Does Not Affect Mid-term Outcomes

BACKGROUND

The purpose of this study was to compare whether different linear stapler lengths used to form the gastrojejunostomy during laparoscopic Roux-En-Y gastric bypass affects mid-term weight loss outcomes.

MATERIALS AND METHODS

A retrospective single center analysis was performed. Surgical technique was identical other than either a 35 or 45 mm linear stapler being used to form the gastrojejunostomy. Multivariate regression was used to assess the relationship between the different stapler lengths and weight loss outcomes 2 years following surgery.

RESULTS

Of the 97 patients identified, 67 (69.1%) were included in the study. There were 30 patients in the 35 mm group and 37 in the 45 mm group. The groups were comparable in terms of basic demographic data and preoperative weight characteristics. There was no significant difference in weight loss outcomes 2 years following surgery when comparing between the different linear stapler lengths.

CONCLUSION

Thirty-five versus 45 mm linear stapler lengths does not affect mid-term weight loss outcomes.