To Örebro University

Background: The use of circular staplers with a low staple height is associated with a lower risk for complication when used to construct the gastroenterostomy in laparoscopic gastric bypass surgery. The influence of staple height on outcome when using linear staplers has not been studied.

Objectives: To investigate the influence of staple height when constructing the gastric pouch and gastroenterostomy using a linear stapler in laparoscopic gastric bypass surgery.

Setting: Nationwide, Sweden.

Methods: A retrospective, register-based cohort study, including all primary laparoscopic gastric bypass surgical procedures in Sweden registered in the Scandinavian Obesity Surgery Registry from January 2010 until January 2017, where linear staplers were used to construct the gastric pouch and the gastroenterostomy. Low stapler heights (closed height <= 1.0 mm) were compared with higher stapler heights (closed height >= 1.5 mm). The main outcome was postoperative complication within 30 days of surgery.

Results: Within the study period, 27,975 patients were identified from the Scandinavian Obesity Surgery Registry. A closed staple height >= 1.5 mm was associated with higher risk for postoperative complication within 30 days of surgery compared with lower staple height. The risk was greater when used to construct the gastric pouch (adjusted odd ratio 1.30, 95% confidence interval 1.17-1.44, P < .001) as well as when constructing the gastroenterostomy (adjusted odd ratio 1.32, 95% confidence interval 1.20-1.45, P < .001).

Conclusion: The use of low staple height for construction of the gastric pouch and gastroenterostomy in laparoscopic gastric bypass surgery was associated with lower complication rates. (C) 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.