TITLE

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

AUTHOR(S)
Gould, Jon Charles; Garren, Michael; Boll, Valerie; Starling, James
PUB. DATE
July 2006
SOURCE
Surgical Endoscopy;Jul2006, Vol. 20 Issue 7, p1017
SOURCE TYPE
Academic Journal
DOC. TYPE
journal article
ABSTRACT
Background: Gastrojejunostomy stenosis after laparoscopic Roux-en-Y gastric bypass is a common occurrence. The incidence varies widely among reported series. We evaluated the impact of circular stapler size on the rate of stenosis and weight loss.Methods: Our initial technique utilized a 21-mm circular stapler to construct the gastrojejunostomy. We switched to a 25-mm stapler after a large preliminary experience. Stenosis was confirmed by endoscopy in patients complaining of the inability to eat or excessive vomiting, and was defined as a gastrojejunostomy diameter less than that of a therapeutic endoscope (11-mm).Results: Stenosis occurred in 23 of 145 patients (15.9%) with a 21-mm gastrojejunostomy. Five of 81 patients with a 25-mm circular stapled anastomosis have developed a stenosis (6.2%, p = 0.03). Weight loss was similar for each sized stapler at 6 and 12 months.Conclusions: 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.
ACCESSION #
21553164

 

Related Articles

  • Learning curve for laparoscopic Roux-en-Y gastric bypass with totally hand-sewn anastomosis: analysis of first 600 consecutive patients. Ballesta-López, C.; Poves, I.; Cabrera, M.; Almeida, J. A.; Macías, G.; Ballesta-López, C; Macías, G // Surgical Endoscopy;Apr2005, Vol. 19 Issue 4, p519 

    Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a challenging operation for the treatment of morbid obesity with well-demonstrated effectiveness in weight lost. There are several variations to the technique.Methods: From September 2000 to July 2004, 600...

  • Robot-assisted versus Laparoscopic Roux-en-Y Gastric Bypass: Is There a Difference in Outcomes? Ayloo, Subhashini M.; Addeo, Pietro; Buchs, Nicolas Christian; Shah, Galaxy; Giulianotti, Pier Cristoforo // World Journal of Surgery;Mar2011, Vol. 35 Issue 3, p637 

    Background: Application of the robot for Roux-en-Y gastric bypass has been slow to evolve, despite its rapid acceptance in other fields. This is largely due to associated costs of technology, reports of increased operative time, and inadequate data available to correlate the benefits of robotics...

  • Single Port Trans-gastric Reversal of High Gastric Reduction. Aly, Ahmad; Sweeney, Thomas; Michell, Ian; Lim, Kiat // Obesity Surgery;Mar2014, Vol. 24 Issue 3, p483 

    Background: Stomal stenosis is common following high gastric reduction or vertical banded gastroplasty for obesity. Open and laparoscopic approaches for reversal can be problematic due to expected adhesions from previous surgery. Methods: A technical description of a novel approach for reversal...

  • Initial experience with a novel endoscopic device allowing intragastric manipulation and plication. Mellinger, John; MacFadyen, Bruce; Kozarek, Richard; Soper, Nathaniel; Birkett, Desmond; Swanstrom, Lee; Mellinger, John D; MacFadyen, Bruce V; Kozarek, Richard A; Soper, Nathaniel D; Birkett, Desmond H; Swanstrom, Lee L // Surgical Endoscopy;Jun2007, Vol. 21 Issue 6, p1002 

    Background: Current developments in intraluminal and transluminal natural orifice surgery are limited by issues of access, tissue manipulation, and secure tissue approximation/closure. This report describes an initial laboratory experience with a novel tissue approximation and...

  • Exercise and Weight Loss Improve Muscle Mitochondrial Respiration, Lipid Partitioning, and Insulin Sensitivity After Gastric Bypass Surgery. Coen, Paul M.; Menshikova, Elizabeth V.; Distefano, Giovanna; Donghai Zheng; Tanner, Charles J.; Standley, Robert A.; Helbling, Nicole L.; Dubis, Gabriel S.; Ritov, Vladimir B.; Hui Xie; Desimone, Marisa E.; Smith, Steven R.; Stefanovic-Racic, Maja; Toledo, Frederico G. S.; Houmard, Joseph A.; Goodpaster, Bret H.; Zheng, Donghai; Xie, Hui // Diabetes;Nov2015, Vol. 64 Issue 11, p3737 

    Both Roux-en-Y gastric bypass (RYGB) surgery and exercise can improve insulin sensitivity in individuals with severe obesity. However, the impact of RYGB with or without exercise on skeletal muscle mitochondria, intramyocellular lipids, and insulin sensitivity index (SI) is unknown. We conducted...

  • Self-expanding nitinol stents: material and design considerations. Stoeckel, Dieter; Pelton, Alan; Duerig, Tom // European Radiology;Feb2004, Vol. 14 Issue 2, p292 

    Nitinol (nickel-titanium) alloys exhibit a combination of properties which make these alloys particularly suited for self-expanding stents. Some of these properties cannot be found in engineering materials used for stents presently. This article explains the fundamental mechanism of shape memory...

  • Circular- vs. Linear-Stapled Gastrojejunostomy in Laparoscopic Roux-En-Y Gastric Bypass. Bohdjalian, Arthur; Langer, Felix B.; Kranner, Andreas; Shakeri-Leidenmühler, Soheila; Zacherl, Johannes; Prager, Gerhard // Obesity Surgery;Apr2010, Vol. 20 Issue 4, p440 

    Different surgical techniques have been developed for the gastrojejunostomy (GJS) in laparoscopic Roux-en-Y gastric bypass (LRYGBP) with the anastomosis performed in a circular-stapled, linear-stapled, or totally hand-sewn way. No technique seems superior to the other as no consistent data on...

  • Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass Nguyen, Ninh T.; Stevens, C. Melinda; Wolfe, Bruce M. // Journal of Gastrointestinal Surgery;Dec2003, Vol. 7 Issue 8, p997 

    Anastomotic stricture is a frequent complication after Roux-en-Y gastric bypass (GBP). We evaluated the frequency of anastomotic stricture following laparoscopic GBP using a 21 mm. vs. a 25 mm circular stapler for construction of the gastrojejunostomy and the safety and efficacy of endoscopic...

  • Low Anastomotic Stricture Rate After Roux-en-Y Gastric Bypass Using a 21-mm Circular Stapling Device. Rondan, A.; Nijhawan, S.; Majid, S.; Martinez, Tracy; Wittgrove, Alan // Obesity Surgery;Sep2012, Vol. 22 Issue 9, p1491 

    Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been established as a safe and effective procedure for morbid obesity management. Amongst some of the postoperative complications are gastrojejunal (GJ) anastomotic strictures, with an incidence of 3 to 27 % in some series. This study...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics