Linear-Stapled Gastrojejunal Anastomosis Linked to Higher Marginal Ulcer Rates After Roux-en-Y Gastric Bypass: A Cohort of 1875 Patients

Abstract

Background:

The three most commonly used surgical techniques for creating the gastrojejunal anastomosis (GJA) during Roux-en-Y gastric bypass (RYGB) are circular-stapled (CS), linear-stapled (LS), and hand-sewn (HS). There is currently no definitive conclusion regarding which one produces the best surgical outcomes. This study aimed to compare the postoperative complications at the GJA based on the surgical technique used.

Methods:

A retrospective cohort study was conducted on patients who underwent RYGB between 2018 and 2023, comparing the surgical technique used for the GJA. The primary outcome of the study was postoperative complications at the GJA: Marginal ulcers (MU), perforation, and stenosis.

Results:

A total of 1875 patients were included. The 63.4% (n = 1189) underwent primary RYGB, and 36.6% (n = 686) underwent sleeve conversion to RYGB. Females were 86.9% (n = 1629), with a mean age of 44.4 ± 11.12 years. Patients who underwent LS had a higher frequency of MU (CS = 8.96%, LS = 12.32%, and HS = 6.12%, P < .001) and overall GJA complications (CS = 6.37%, LS = 7.82%, and HS = 3.95%, P < .01). The frequency of GJA perforations and stenosis was also higher in patients with LS, although no statistically significant difference. In multivariable analysis, LS anastomosis (OR = 1.74, P = .042), age of >65 years old (OR = 3.8, P = .004), and albumin of < 3.5 mg/dL (OR = 4.5, P = .021) were significant independent predictors of MU at the GJA after RYGB.

Conclusions:

In patients undergoing RYGB, whether as a conversion or primary procedure, the overall complication rates for GJA and MUs were higher in those who underwent LS compared with those who received CS or HS anastomosis.