Low Anastomotic Stricture Rate After Roux-en-Y Gastric Bypass Using a 21-mm Circular Stapling Device

Abstract

We hereby demonstrate that the construction of GJ anastomosis with a 21-mm circular stapler is associated with a low stricture rate using our standardized technique. Strictures are amenable to balloon dilatation with subsequent long-term resolution of symptoms.

Does Robotic Roux-en-Y Gastric Bypass Provide Outcome Advantages over Standard Laparoscopic Approaches?

“…Sima et al reported a greater incidence of vomiting and need for endoscopic dilation over a 5-year follow-up period in those patients for whom the C21 technique was used for GJA [ 14 ]. However, some authors have demonstrated low rates of GJ stricture with the 21-mm staplers (0.8–5.9%) [ 16 , 17 ]. Factors associated with formation of stricture at the GJA include a 21-mm diameter CS and a 4.5-mm staple height.…”

The Effect of Route of Anvil Insertion on Stricture Rates with Circular Stapled Gastrojejunostomy During Laparoscopic Gastric Bypass

“…Others have obtained a low rate of stricture using a 21-mm inserted trans-orally, but passing the anvil into the posterior wall of the gastric pouch but noting if specifically incorporating the gastric pouch staple line. Rondan et al reported 4.7 % stricture rate in 338 cases of LRYGB which were performed using 21 mm circular staplers [5]. The authors, however, attributed this low rate partly to the tension-reducing effect of the retrogastric, retrocolic approach they used for the alimentary limb and the anterior stitches at the GJ anastomosis [5].…”

“…Rondan et al reported 4.7 % stricture rate in 338 cases of LRYGB which were performed using 21 mm circular staplers [5]. The authors, however, attributed this low rate partly to the tension-reducing effect of the retrogastric, retrocolic approach they used for the alimentary limb and the anterior stitches at the GJ anastomosis [5]. On the contrary, all cases in our series were performed with an antegastric antecolic fashion and we obtained a similar stricture rate using the 21-mm than Rondan et al and Suter et al; both of which employed retrocolic passage of the alimentary limb.…”

“…Since the introduction of the laparoscopic technique in 1994 [5], a variety of surgical techniques to construct the GJ anastomosis have been developed, yielding different rates of stricture formation: from 3 to 8 % with hand-sewn, 0 to 6 % with linear stapled, and 5 to 31 % with circular stapled anastomoses [4][5][6][7][8][9][10][11][12][13][14][15][16]. Many series have shown that the use of a 21-mm circular stapler is associated with higher rates of stricture, and most surgeons prefer the use of 25-mm circular staplers to avoid this complication [4][5][6][7][8][9][10][11].…”

“…However, others have demonstrated low rates of GJ stricture with the 21-mm staplers when the anvil is inserted orally [3] and delivered through the staple line [5].…”