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Systematic Review and Meta-analysis of Circular- and Linear-Stapled Gastro-jejunostomy in Laparoscopic Roux-en-Y Gastric Bypass

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Abstract

To compare circular stapler (CS) with linear stapler (LS) in a meta-analysis concerning operative time, anastomotic leaks, wound infections, strictures, and length of stay. Pubmed, Medline, and Scopus were searched for articles published since 2006. Four hundred and five articles were assessed, and 13 articles of which only one was a randomized controlled trial were included in all 49,331 patients from different regions of the world. The pooled analysis shows that operative time was shorter in LS than in CS (weighted mean difference 36.2 min; 95% CI 34.7–37.6.; p < 0.0001). No difference was seen concerning leaks or strictures. The relative risk (RR) of leakage after LS was 80% of the risk after CS; however, the 95% confidence interval (CI) showed overlap (0.58–1.11). The RR of anastomotic stricture after LS was 74% of the risk after CS; however, 95% CI (0.52–1.05) showed overlap. Wound infections were less common after LS than after CS; RR was 27% (95% CI 0.21–0.33). Length of stay (LOS) was 0.65 days shorter after LS than after CS (95% CI 0.51–0.78). LS compared with CS results in shorter operative time, less wound infections, and shorter length of stay, but no difference was seen concerning risks of leaks or strictures.

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References

  1. Angrisani L, Santonicola A, Iovino P, et al. IFSO Worldwide Survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28(12):3783–94.

    Article  Google Scholar 

  2. Vidarsson B, Sundbom M, Edholm D. Shorter overall operative time when barbed suture is used in primary laparoscopic gastric bypass: a cohort study of 25,006 cases. Surg Obes Relat Dis. 2017;13(9):1484–8.

    Article  Google Scholar 

  3. Stroh C, Nesterov G, Weiner R, et al. Circular versus linear versus hand-sewn gastrojejunostomy in Roux-en-Y-gastric bypass: data analysis from a quality assurance study of the surgical treatment of obesity in Germany. Surg Sci. 2014;2014(5):280–9.

    Article  Google Scholar 

  4. Edholm D, Sundbom M. Comparison between circular-and linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass—a cohort from the Scandinavian Obesity Registry. Surg Obes Relat Dis. 2015;11(6):1233–6.

    Article  Google Scholar 

  5. Finks JF, Carlin A, Share D, et al. Effect of surgical techniques on clinical outcomes after laparoscopic gastric bypass—results from the Michigan Bariatric Surgery Collaborative. Surg Obes Relat Dis. 2011;7(3):284–9.

    Article  Google Scholar 

  6. Giordano S, Salminen P, Biancari F, et al. Linear stapler technique may be safer than circular in gastrojejunal anastomosis for laparoscopic Roux-en-Y gastric bypass: a meta-analysis of comparative studies. Obes Surg. 2011;21(12):1958–64.

    Article  Google Scholar 

  7. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.

    Article  Google Scholar 

  8. Bohdjalian A, Langer FB, Kranner A, et al. Circular- vs. linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2010;20(4):440–6.

    Article  Google Scholar 

  9. Giordano S, Tolonen P, Victorzon M. Comparison of linear versus circular stapling techniques in laparoscopic gastric bypass surgery—a pilot study. Scand J Surg. 2010;99(3):127–31.

    Article  CAS  Google Scholar 

  10. Bendewald FP, Choi JN, Blythe LS, et al. Comparison of hand-sewn, linear-stapled, and circular-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2011;21(11):1671–5.

    Article  Google Scholar 

  11. Qureshi A, Podolsky D, Cumella L, et al. Comparison of stricture rates using three different gastrojejunostomy anastomotic techniques in laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2015;29(7):1737–40.

    Article  Google Scholar 

  12. Schneider R, Gass J-M, Kern B, et al. Linear compared to circular stapler anastomosis in laparoscopic Roux-en-Y gastric bypass leads to comparable weight loss with fewer complications: a matched pair study. Langenbeck’s Arch Surg. 2016;401(3):307–13.

    Article  Google Scholar 

  13. Vines L, Frick T, Aczél S, et al. Linear stapled gastrojejunostomy results in fewer strictures compared to circular stapled gastrojejunostomy in laparoscopic gastric bypass surgery. Langenbeck’s Arch Surg. 2017;402(6):911–6.

    Article  Google Scholar 

  14. Khalayleh H, Pines G, Imam A, et al. Anastomotic stricture rates following Roux-en-Y gastric bypass for morbid obesity: a comparison between linear and circular-stapled anastomosis. J Laparoendosc Adv Surg Tech A. 2018;28(6):5.

    Article  Google Scholar 

  15. Lee S, Davies AR, Bahal S, et al. Comparison of gastrojejunal anastomosis techniques in laparoscopic Roux-en-Y gastric bypass: gastrojejunal stricture rate and effect on subsequent weight loss. Obes Surg. 2014;24(9):1425–9.

    Article  Google Scholar 

  16. Leyba JL, Llopis SN, Isaac J, et al. Laparoscopic gastric bypass for morbid obesity—a randomized controlled trial comparing two gastrojejunal anastomosis techniques. JSLS. 2008;12(4):385–8.

    PubMed  PubMed Central  Google Scholar 

  17. Major P, Janik MR, Wysocki M, et al. Comparison of circular- and linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass: a multicenter study. Wideochir Inne Tech Maloinwazyjne. 2017;12(2):140–6.

    PubMed  PubMed Central  Google Scholar 

  18. Reames BN, Bacal D, Krell RW, et al. Influence of median surgeon operative duration on adverse outcomes in bariatric surgery. Surg Obes Relat Dis. 2015;11(1):207–13.

    Article  Google Scholar 

  19. Stenberg E, Szabo E, Agren G, et al. Early complications after laparoscopic gastric bypass surgery: results from the Scandinavian Obesity Surgery Registry. Ann Surg. 2013;260:1040–7.

    Article  Google Scholar 

  20. Chen J, Miller M, Ibele A, et al. Dual ring wound protector reduces circular stapler related surgical site infections in patients undergoing laparoscopic Roux-En-Y gastric bypass. Obes Surg. 2018;28(10):3352–9.

    Article  Google Scholar 

  21. Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg. 1994;4(4):353–7.

    Article  CAS  Google Scholar 

  22. Nguyen NT, Hinojosa MW, Smith BR, et al. Advances in circular stapling technique for gastric bypass: transoral placement of the anvil. Obes Surg. 2008;18(5):611–4.

    Article  Google Scholar 

  23. Csendes A, Burgos AM, Burdiles P. Incidence of anastomotic strictures after gastric bypass: a prospective consecutive routine endoscopic study 1 month and 17 months after surgery in 441 patients with morbid obesity. Obes Surg. 2009;19(3):269–73.

    Article  Google Scholar 

  24. Fisher BL, Atkinson JD, Cottam D. Incidence of gastroenterostomy stenosis in laparoscopic Roux-en-Y gastric bypass using 21-or 25-mm circular stapler: a randomized prospective blinded study. Surg Obes Relat Dis. 2007;3(2):176–9.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linkoping, Sweden

    David Edholm

  2. University Hospital Linköping, 581 85, Linkoping, Sweden

    David Edholm

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  1. David Edholm
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Correspondence to David Edholm.

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Edholm, D. Systematic Review and Meta-analysis of Circular- and Linear-Stapled Gastro-jejunostomy in Laparoscopic Roux-en-Y Gastric Bypass. OBES SURG 29, 1946–1953 (2019). https://doi.org/10.1007/s11695-019-03803-w

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