Linear stapled gastrojejunostomy results in fewer strictures
compared to circular stapled gastrojejunostomy in laparoscopic
gastric bypass surgery
Received: 12 February 2017 /Accepted: 21 June 2017 /Published online: 8 July 2017
Springer-Verlag GmbH Germany 2017
Purpose Currently, there are two laparoscopic stapling tech-
niques to perform the gastrojejunostomy in gastric bypass sur-
gery: the linear stapling and circular stapling techniques. The
aim of the study was to compare the two techniques regarding
postoperative morbidity and weight loss at an accredited bar-
iatric reference center in Switzerland.
Methods We compared two consecutive cohorts at a single
institution between November 2012 and June 2014 undergoing
laparoscopic gastric bypass surgery. The frequency of compli-
cations and weight loss at 1 year was assessed in 109 patients
with the 21-mm circular stapling technique (CSA) and 134
patients with the linear stapling technique (LSA).
Results Postoperative complications were more frequent in
the CSA group with 23.9 versus 4.5% in the LSA group
(p = <0.0001). The main difference was the frequency of
strictures, which occurred in 15.6% in the CSA group versus
0% in the LSA group. As a result, endoscopic dilation was
required at least once in 15 patients. There was no statistically
significant difference in percentage of excessive weight loss
(EWL) in both groups; EWL was 74% in the CSA group and
73% in the LSA group (p =0.68).
Conclusion Linear stapled laparoscopic gastric bypass had
fewer stenotic strictures with similar weight loss at 1 year
compared to circular stapling technique.
Keywords Linear stapling anastomosis
Bariatric surgery is considered the most effective treatment for
morbid obesity and results in substantial weight loss as well as
in an improvement of the obesity-associated comorbidities,
such as arterial hypertension, diabetes mellitus type II, sleep
apnea, and hypercholesterolemia [1, 2]. In 2013, a total of
468,609 bariatric procedures were performed worldwide,
95.7% of which were conducted laparoscopically . Today,
one of the most frequently performed techniques is still the
laparoscopic Roux-en-Y-Gastric Bypass (LRYGB), which
was first introduced by Wittgrove et al. in 1993 . The critical
step of the operation is the gastrojejunostomy. Currently, there
are two standard stapling techniques for the gastrojejunostomy:
the circular stapling anastomosis (CSA) as described early by
Wittgrove and Clark  and the linear stapling anastomosis
(LSA) as described by Williams and Champion . The main
objective is to achieve a low frequency of complications, such
as leaks, strictures, and marginal ulcer at the anastomosis.
While the leakage rate has dropped dramatically to less than
3% within the last decades, the occurrence of anastomotic stric-
tures and stenosis has been reported for both techniques and it
The results of this study have been presented at the 103rd Annual
Congress of the Swiss Society of Surgery and the abstract was
published in the BJS in 2016.
* Marc Schiesser
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St.
Klinik für Endokrinologie, Kantonsspital St. Gallen,
Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
Ostschweizer Kinderspital, St. Gallen, Claudiusstrasse 6, 9006 St.
Klinik für Gastroenterologie und Hepatologie, Kantonsspital St.
Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
Langenbecks Arch Surg (2017) 402:911–916