Size really does matter—role of gastrojejunostomy in postoperative weight loss

Abstract 

Background

Although the published data have clearly related the size of the gastrojejunostomy anastomosis to the subsequent likelihood of a stricture, a correlation between the anastomosis size and postoperative weight loss has not previously been described.

Methods

A retrospective comparison was made of 124 anastomoses accomplished with the 21-mm circular stapler followed by 100 anastomoses created with the 45-mm linear stapler technique at 6 community hospitals in Southern California. Age, gender, and preoperative weights were not significantly different between the 2 groups. The precise size of the anastomosis created using the linear stapler technique could not be determined, but it was calculated to be slightly larger than a 25-mm circular stapled anastomosis. Both weight loss trends were fit with a 1-phase exponential nonlinear regression analysis. The resulting curves were compared using an F test. A 1-tailed t test was also used to compare the weight loss at 12 months.

Results

An F test comparison of the exponential weight loss curves generated by the 2 anastomosis groups showed a significantly different trend in weight loss (P <.001). A 1-tailed t test comparison of the 2 groups at 12 months revealed significantly different results (p <.0025).

Conclusion

The results of this study show that the size of the anastomosis has a clear correlation with postoperative weight loss. A smaller opening results in significantly more weight loss.

Keywords: Weight loss, Linear anastomosis, Circular anastomosis, Gastric bypass, Gastrojejunostomy, Surgical technique