Linear versus Circular Stapled Gastrojejunostomy in Minimally Invasive Roux-en-Y Gastric Bypass: A Nationwide Swiss Administrative Database Study (2015-2022).

IF 3.4 3区医学 Q1 SURGERY

Obesity Surgery Pub Date : 2026-10-16 DOI:10.1007/s11695-026-08982-x

Yanic Ammann, Rene Warschkow, Marie Klein, Romano Schneider, Beat Müller, Loriana Lisarelli, Ignazio Tarantino, Patrick Folie

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引用次数: 0

Abstract

Background: The impact of stapling technique on early postoperative outcomes after minimally invasive Roux-en-Y gastric bypass (RYGB) remains incompletely understood. This study compared short-term postoperative outcomes following linear versus circular gastrojejunostomy.

Methods: This nationwide administrative database study included RYGB cases in Switzerland between 2015 and 2022. The primary endpoint was major in-hospital postoperative complication (composite of diagnoses and reoperation). Secondary endpoints included individual complications, length of hospital stay (LOS), and temporal trends in stapling technique. Associations were assessed using generalised additive regression models and propensity score matching (PSM).

Results: Among 21,320 RYGB cases, 18,161 (85.2%) underwent linear and 3,159 (14.8%) circular gastrojejunostomy. Circular stapling was not associated with major complication in multivariable analysis (OR = 1.221, 95% CI 0.824-1.809), whereas higher odds were observed after PSM (OR = 2.464, 95% CI 1.225-4.956). Circular stapling was associated with both surgical site infection (SSI) and LOS exceeding the 50th percentile in both multivariable (SSI: OR = 2.251, 95% CI 1.331-3.809; LOS: RR = 1.136, 95% CI 1.047-1.232) and PSM analyses (SSI: OR = 7.647, 95% CI 2.885-20.271; LOS: RR = 1.318, 95% CI 1.218-1.426). For LOS exceeding the 90th percentile, an association was observed in multivariable analysis (RR = 1.209, 95% CI 1.014-1.441), but not after PSM (RR = 1.018, 95% CI 0.604-1.715). Circular stapling decreased overall during the study period (Τ=-0.714, p = 0.013), despite year-to-year variation.

Conclusion: The association between circular stapling and major in-hospital postoperative complication differed across analytical approaches. Associations with SSI and prolonged LOS were more consistent. Linear stapling increasingly predominated over time. Registry: ClinicalTrials.gov, TRN: NCT07483957, Registration date: 17 March 2026.

查看原文本刊更多论文

线性与圆形吻合器胃空肠吻合术在微创Roux-en-Y胃旁路术中的应用：瑞士全国行政数据库研究（2015-2022）。

背景：吻合器技术对微创Roux-en-Y胃旁路术（RYGB）术后早期预后的影响尚不完全清楚。本研究比较了线性胃空肠吻合术与圆形胃空肠吻合术的短期术后结果。方法：这项全国性的行政数据库研究包括瑞士2015年至2022年的RYGB病例。主要终点是院内主要术后并发症（诊断和再手术的综合）。次要终点包括个体并发症、住院时间（LOS）和吻合器技术的时间趋势。使用广义加性回归模型和倾向评分匹配（PSM）评估关联。结果：在21320例RYGB患者中，18161例（85.2%）行线性胃空肠吻合术，3159例（14.8%）行环形胃空肠吻合术。在多变量分析中，环形吻合器与主要并发症无关（OR = 1.221, 95% CI 0.824-1.809），而PSM后的发生率更高（OR = 2.464, 95% CI 1.225-4.956）。在多变量分析（SSI: OR = 2.251, 95% CI 1.331-3.809; LOS: RR = 1.136, 95% CI 1.047-1.232）和PSM分析（SSI: OR = 7.647, 95% CI 2.885-20.271; LOS: RR = 1.318, 95% CI 1.218-1.426）中，圆形吻合器与手术部位感染（SSI: SSI）和LOS均超过50百分位相关。对于LOS超过90百分位，在多变量分析中观察到相关性（RR = 1.209, 95% CI 1.014-1.441），但在PSM后没有相关性（RR = 1.018, 95% CI 0.604-1.715）。尽管每年都有变化，但在研究期间，循环订书量总体上有所下降（Τ=-0.714, p = 0.013）。结论：环形吻合器与院内主要术后并发症的关系因分析方法的不同而不同。与SSI和延长的LOS的关联更为一致。随着时间的推移，线性订书机越来越占主导地位。注册：ClinicalTrials.gov, TRN: NCT07483957，注册日期：2026年3月17日。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Obesity Surgery 医学-外科

CiteScore

5.80

自引率

24.10%

发文量

567

审稿时长

3-6 weeks

期刊介绍： Obesity Surgery is the official journal of the International Federation for the Surgery of Obesity and metabolic disorders (IFSO). A journal for bariatric/metabolic surgeons, Obesity Surgery provides an international, interdisciplinary forum for communicating the latest research, surgical and laparoscopic techniques, for treatment of massive obesity and metabolic disorders. Topics covered include original research, clinical reports, current status, guidelines, historical notes, invited commentaries, letters to the editor, medicolegal issues, meeting abstracts, modern surgery/technical innovations, new concepts, reviews, scholarly presentations and opinions. Obesity Surgery benefits surgeons performing obesity/metabolic surgery, general surgeons and surgical residents, endoscopists, anesthetists, support staff, nurses, dietitians, psychiatrists, psychologists, plastic surgeons, internists including endocrinologists and diabetologists, nutritional scientists, and those dealing with eating disorders.