The impact of circular stapler diameter on the incidence of gastrojejunostomy stenosis and weight loss following laparoscopic Roux-en-Y gastric bypass

Gould, Jon C.; Garren, Michael; Boll, Valerie; Starling, James R.

doi:10.1007/s00464-005-0207-5

Cited by 82 publications

(59 citation statements)

References 17 publications

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“…Thus, the results of the multivariate analysis of our data confirm the existing literature, showing that type of surgery and gastrojejunal construction do not significantly influence clinical results. 22,23 In line with the available published data, 5,6,8,14,17,24,26 super-obesity has shown in our analysis to be a strong risk factor for BMI trend over time. Even though heavier patients can lose greater absolute amounts of weight, they lose a smaller percentage of their excess weight than leaner patients,27 and they tend to remain obese.14 But the most important and not yet described result of the present study was that operative age was a statistically significant modifier of the BMI trend over time.…”

Section: Discussionsupporting

confidence: 73%

Age as a Long-Term Prognostic Factor in Bariatric Surgery

et al. 2012

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Objective: To analyze the potential effects of preoperative age on postoperative weight loss in patients who underwent Roux-en-Y gastric bypass (RYGBP) with long-term follow-up data. Background: The reasons for individual differences in surgically induced weight loss are not completely understood. To date, there are no available studies specifically aimed at analyzing the effects of age on weight loss in patients undergoing the same operation and with long-term followup data. Methods: Retrospective analysis of prospectively collected data for all patients who underwent RYGBP between 2006 and 2010. To evaluate weight loss, we used preoperative and follow-up body mass index (BMI), analyzed by the mixed-effects linear model for repeated measures. To evaluate age effects, patients were classified in quartiles (<=35 years, 36-42 years, 43-51 years, >=52 years). Results: A total of 489 patients entered the study; preoperatively, the younger group showed a significantly higher BMI (mean BMI: 48.2 in patients aged <=35 years, 46.9 in 36-42 years, 45.5 in 43-51 years, 45.7 in >=52 years, P = 0.014) and a higher percentage of super-obesity (41.6% among patients aged <=35 years, 28.1% among 36-42 years, 27.6% among 43-51 years, 28.3% among >= 52 years, P = 0.047). In spite of this, younger patients experienced a significantly greater and prolonged BMI decrease during the entire follow-up period and the BMI trend over time resulted significantly modified according to age quartiles (P = 0.036). Conclusions: This study provides a new prognostic factor in bariatric surgery: patient age. Because advanced age represents a risk factor for complications and mortality, and given that bariatric surgery may not be as effective in older patients compared to younger subjects, we believe that surgical indications in patients older than 50 years should be carefully weighed up.

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Section: Discussionsupporting

confidence: 73%

Age as a Long-Term Prognostic Factor in Bariatric Surgery

et al. 2012

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“…The incidence of stenosis varies sometimes widely between series using the same technique. However, the results of new publications [32,33] indicate that the use of a 25-mm circular stapler for laparoscopic gastric bypass is preferable to the use of a 21-mm stapler. The larger stapler is associated with a significantly decreased incidence of gastrojejunostomy stenosis.…”

Section: Discussionmentioning

confidence: 93%

RETRACTED ARTICLE: First Experiences with A Circular Stapled Gastro-Jejunostomy by a New Transorally Introducible Stapler System in Laparoscopic Roux-en-Y Gastric Bypass

et al. 2008

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Performing of a gastrojejunostomy in RYGBP by SurgASSIST is a safe and feasible method in comparison to conventional circular stapler systems. The advantage of SurgASSIST is the avoidance to introduce the stapler through the abdominal wall and, by this, a possible port site wound infection. Further prospective studies have to be performed to verify the advantages of the SurgASSIST in comparison to conventional circular stapler systems.

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“…However, it would be more difficult to manipulate a circular stapler in a limited space than a linear stapler. In addition, the use of a circular stapler could result in a higher rate of anastomotic stenosis (which is the most frequent complication following proximal gastrectomy), in comparison to the rate with a hand-sewn anastomosis [7,8]. In the present study, the mean duration for the reconstruction with the hand-sewn anastomosis was about 80 min.…”

Section: Discussionmentioning

confidence: 74%

“…This results in the remnant stomach surrounding the dorsal half of the lower esophagus, increasing the pressure at the lower end of the esophagus and thereby preventing esophageal reflux by mechanisms similar to those of partial fundoplication. Although a gastroesophageal anastomosis can be done with a circular stapler, anastomotic stenosis can occur in 6-20 % of patients a few months or even later after such a procedure [7,8]. We have adopted a hand-sewn anterior esophago-gastric anastomosis in open proximal gastrectomy because the incidence of stenosis was reported to be lower with hand-sewn sutures [9].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic proximal gastrectomy with a hand-sewn esophago-gastric anastomosis using a knifeless endoscopic linear stapler

et al. 2012

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Proximal gastrectomy has been applied for selected patients with early upper gastric cancer, because of its potential advantages over total gastrectomy, such as preserving gastric capacity and entailing fewer hormonal and nutritional deficiencies. Esophago-gastric anastomosis is a simple reconstruction method with an excellent postoperative outcome provided that gastroesophageal reflux is properly prevented. Following open surgery, the esophagus is anastomosed to the anterior stomach wall with partial fundoplication to prevent esophageal reflux. We developed a novel laparoscopic hand-sewn method to reproduce the anti-reflux procedure that is used in open surgery. The esophagus is first fixed to the anterior stomach wall with a knifeless endoscopic linear stapler. This fixation contributes to maintaining a stable field for easier hand-sewn anastomosis, and allows us to complete the left side of the fundoplication at the same time. This novel technique was used to successfully perform complete laparoscopic proximal gastrectomy with a hand-sewn esophago-gastric anastomosis in ten patients, without any postoperative complications. No patient had symptoms of gastroesophageal reflux during a median follow-up period of 19.9 months. One patient developed anastomotic stenosis, and this was resolved with endoscopic dilatation. The mean percent body weight loss at 12 months after surgery, in comparison to the preoperative weight, was 10.4 %. Laparoscopic proximal gastrectomy with an esophago-gastric anastomosis using our novel technique would be a feasible choice would be a feasible choice and would show benefit for selected patients with early upper gastric cancer.

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The impact of circular stapler diameter on the incidence of gastrojejunostomy stenosis and weight loss following laparoscopic Roux-en-Y gastric bypass

Abstract: The use of a 25-mm circular stapler in laparoscopic gastric bypass is preferable to a 21-mm stapler. The larger stapler is associated with a significantly decreased incidence of gastrojejunostomy stenosis without compromising early weight loss.

Cited by 82 publications

References 17 publications

Age as a Long-Term Prognostic Factor in Bariatric Surgery

Age as a Long-Term Prognostic Factor in Bariatric Surgery

RETRACTED ARTICLE: First Experiences with A Circular Stapled Gastro-Jejunostomy by a New Transorally Introducible Stapler System in Laparoscopic Roux-en-Y Gastric Bypass

Laparoscopic proximal gastrectomy with a hand-sewn esophago-gastric anastomosis using a knifeless endoscopic linear stapler

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