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Schneider, Romano; Gass, Jörn-Markus; Kern, Beatrice; Peters, Thomas; Slawik, Marc; Gebhart, Martina and Peterli, Ralph (2016): 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. In: Langenbecks Archives of Surgery, Vol. 401, No. 3: pp. 307-313

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Objective In the course of laparoscopic Roux-en-Y gastric bypass (LRYGB), a tight gastroenterostomy (GE) may lead to higher weight loss but possibly to an increase of local complications such as strictures and ulcers. Different operative techniques for Roux-en-Y reconstruction may also influence the rate of internal hernias, a typical late complication of LRYGB. The objective of this study was to compare weight loss, rates of strictures, internal hernias, and ulcerations of linear versus circular stapler anastomosis. Methods Retrospective analysis of prospectively collected data in a 3: 1-matched pair study. A total of 228 patients with a minimal follow-up of 2 years were matched according to BMI at baseline, age, and gender. The follow-up rate was 100 % at 1 and 2 years postoperatively;the mean follow-up time was 3.8 +/- 1.63 years. In group C (circular), 57 patients were operated with a 25-mm circular stapler technique (average BMI 44.7 +/- 5.18 kg/m(2), age 44.1 +/- 10.8 years, 80.7 % female). In group L (linear), 171 patients were operated using a linear stapler (approximately 30 mm, average BMI 43.8 +/- 5.24 kg/m(2), age 43.7 +/- 12.5 years, 70.8 % female). A propensity score matching and a log rank test were used for statistical analysis. Results The average excessive BMI loss (EBMIL) after 1 year was not statistically different (70.6 +/- 20.2 % in group C vs 72.5 +/- 20.4 % in group L) as well as after 2 years (71.6 +/- 22.5% in group C vs 74.6 +/- 19.6% in group L). The average operation time was 155 +/- 53 min in group C and 109 +/- 57 min in group L (p = 0.0001). In group L, patients had significantly lower overall stricture rates at the GE compared to group C (0 [0 %] vs. 4 [7 %], p = 0.0004), a lower rate and severity of internal hernias (10 [5.8 %] vs. 7 [12.3 %] p = 0.466), and equal local ulcerations rates (3 [1.8 %] vs. 1 [1.8 %] p = 0.912). Conclusion Linear stapler anastomosis in LRYGB compared to circular anastomosis leads to equal weight loss and less strictures. The lower rate of internal hernias in linear stapler anastomosis was not significantly different.

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