COMPARISON OF LINEAR VERSUS CIRCULAR STAPLING TECHNIQUES IN LAPAROSCOPIC GASTRIC BYPASS SURGERY - A PILOT STUDY

Background: There is major variability in how the gastrojejunostomy (GJ) is created when laparoscopic gastric bypass (LRYGB) is performed. This is a prospective, non-randomised pilot comparison of two different techniques during our learning curve period performed by two different surgeons with similar surgical experience. Methods: From March 2006 until May 2008, 71 consecutive patients, 28 men and 43 woman, mean age 44 (range 24 to 62 years) who were operated for morbid obesity by laparoscopic bypass surgery have been included. Mean preoperative Body Mass Index (BMI) (range) was 47 (34-63). The patients were divided into two groups on the basis of the stapler used. Group 1 comprised 30 patients who underwent surgery using a 25 mm circular stapler to create the GJ. Group 2 comprised 41 patients who underwent surgery using a 45 mm, blue cartridge linear stapler. Operative time, intra-operative complications, hospital stay, major and minor complications were detected. Results: Intra-operative complications occurred in 4 patients (13.3%) in Group 1, in 5 patients (12.2%) in Group 2. Re-operations occurred 3 times (10.0%) in Group 1, and 4 times (9.8%) in Group 2 due to anastomotic complications, bleeding and/or bowel obstruction. Major complications occurred in four patients in Group 1 (13.3%) and in seven patients in Group 2 (17.1%). There was a significant difference in the overall morbidity rate (major and minor complications), which was 56.7% in Group 1 and 34.1% in Group 2 (p=0.05). Mean operative time in Group 1 was 135 minutes, and in Group 2 122 minutes. Mean hospital stay was significantly shorter in Group 2 (3.9 days) than in Group 1 (5.7 days, p=0.04). Conclusions: Learning to handle the technique when performing the gastrojejunostomy during laparoscopic gastric bypass surgery may be faster and easier by using the linear stapler. This may be important knowledge for centres considering starting LRYGB practice, although the surgeon factor needs to be taken in account. The results should be interpreted with caution because the confounding effect of one surgeon performing one type of operation while the other surgeon (is performing) the second type of operation could not be taken into account in this prospective non-randomized analysis.