The effect of linear stapled gastrojejunostomy size in Roux-en-Y gastric bypass

• Published in: Canadian Journal of Surgery 2022-11, Vol.65, p.S91-S91
• Main Authors: Ahn, Hilalion (San), Gu, Jeffrey, Jarrar, Amer, Kolozsvari, Nicole
• Format: Article
• Language: English
• Subjects: Gastrointestinal surgery
• ISSN: 0008-428X; 1488-2310

Background: The creation of the linear stapled gastrojejunostomy (GJ) is a crucial step in Roux-en-Y gastric bypass (RYGB) surgery as its associated complications carry significant morbidity and mortality. However, there remains significant variability in practice regarding the size of stapler used, with 30 mm or 45 mm staplers being most common. The objective of this study was to determine whether weight loss or complications differ with 30 mm v. 45 mm GJ size. Methods: This was a retrospective cohort study of consecutive patients who underwent RYGB between January 2010 and May 2020. Patient data were obtained from the Ontario Bariatric Network Registry. GJ size and bypass limb lengths were confirmed with each individual surgeon included in the study. The primary outcome was weight loss at 1 year. Secondary outcomes included weight loss beyond 1 year, stenosis and erosions. For all statistical tests, 2-tailed t tests were performed to determine significance at p < 0.05. Analysis of covariance was used for covariate adjustments. Results: All included patients (n = 6135) had either a 30 mm (n = 4336) or 45 mm (n = 1799) linear stapled GJ. Percent total weight loss (%TWL) at 1 year for the 30 mm and 45 mm groups was 31.02% and 32.18%, respectively (mean difference 1.16%, 95% confidence interval [CI] 0.68-1.64, p < 0.001) and at 3 years was 29.51% and 30.16%, respectively. When adjusting for baseline body mass index, waist circumference, age, gender, and total limb length, %TWL at 1 year was 30.21% and 31.27% for the 30 mm and 45 mm groups, respectively (mean difference 1.06%, 95% CI 0.23-1.89, p = 0.01). At I year, stenosis rates for the 30 mm and 45 mm groups were 1.13% (n = 4) and 4.35% (n = 5), respectively, and erosion rates were 32.96% (n = 117) and 32% (n = 37), respectively. Conclusion: Owing to the very large sample size, a statistically significant difference in %TWL was detected, favouring the 45 mm GJ. However, the differences in weight loss were not clinically meaningful. Both the 30 mm and 45 mm linear stapled GJ provide excellent sustained weight loss.