Comparison of two different circular-stapler techniques for creation of gastrojejunostomy anastomosis in bariatric Roux-en Y gastric bypass.

BACKGROUND Circular-stapled anastomosis with trans-oral anvil insertion is one of the most commonly used methods for the creation of the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass (LRYGB). We present a retrospective analysis of laparoscopic gastric bypass by comparing 2 techniques of circular-stapled gastrojejunostomy; Orvil(TM) and hand-made Orvil. METHODS Patients who were subjected to LRYGB without any concomitant procedures were observed over a 13-months period at the "Obesity clinic of a University". A total of 94 patients with morbid obesity were subjected to LRYGB. Gastrojejunostomy with circular-stapler and Orvil(TM) (CS-O) was performed to 58 patients and 36 patients underwent through the surgery with circular-stapler and hand-made Orvil (CS-HMO). Demographics, clinic, intraoperative data, postoperative complications, and the length of hospital stay were evaluated. RESULTS Ninety-four patients with mean age of 37.2 years and average body mass index of 58.1 kg/m(2) underwent laparoscopic Roux-en-Y gastric bypass. Laparoscopic surgeries of all patients were successful and major intraoperative complications were not reported. Demographic data and complication rates were similar in both groups. The operative time in group CS-HMO was significantly higher (P=0.03) when compared to group CS-O. There was no anastomotic leak in both groups. CONCLUSION The use of hand-made Orvil is a technically feasible and safe method for performing the gastrojejunostomy. This technique can be successfully used in case of difficulties for obtaining the Orvil(TM) or reducing the operational costs.