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Linear-stapled Versus Circular-stapled Laparoscopic Gastrojejunal Anastomosis in Morbid Obesity: Meta-analysis

Penna, Marta MBBS, BSc*; Markar, Sheraz R. MRCS, MA*; Venkat-Raman, Vishal MBBS, BA*; Karthikesalingam, Alan MRCS, MA; Hashemi, Majid MD, FRCS*

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques: April 2012 - Volume 22 - Issue 2 - p 95–101
doi: 10.1097/SLE.0b013e3182470f38
Review Articles

Background: The study aims to provide a pooled analysis of individual small trials comparing linear-stapled versus circular-stapled laparoscopic gastrojejunal (GJ) anastomosis in morbid obesity surgery.

Methods: A systematic literature search of Medline, Embase, and Cochrane library databases was performed. Primary outcomes were GJ leak and stricture. Secondary outcomes were operative time, length of hospital stay, postoperative bleeding, wound infection, marginal ulcers, and estimated weight loss. Pooled odds ratios were calculated for categorical outcomes and weighted mean differences for continuous outcomes.

Results: Nine trials were included comprising 9374 patients (2946 linear vs. 6428 circular). Primary outcome analysis revealed a statistically significant increase in the rate of GJ stricture associated with circular-stapled anastomosis. A significantly reduced rate of wound infection, bleeding, and operative time associated with linear stapling was also found. No significant differences appeared for the other outcomes.

Conclusions: This pooled analysis recommends the preferential use of the linear stapling technique over circular stapling.

Supplemental Digital Content is available in the text.

*UCLH Department of Weight Loss, Metabolic and Endocrine Surgery, University College London Hospital

Department of General Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK

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The authors declare no conflicts of interest.

Presented at the American Society for Metabolic and Bariatric Surgery 2011.

Reprints: Marta Penna, MBBS, BSc, UCLH Department of Weight Loss, Metabolic and Endocrine Surgery, University College London Hospital, 235 Euston Road, London, UK (e-mail:

Received May 6, 2011

Accepted November 14, 2011

© 2012 Lippincott Williams & Wilkins, Inc.