A influência do tamanho da gastrojejunoanastomose na perda de peso pós-operatória do bypass gástrico: comparação entre 15 e 45 mm

Background: The laparoscopic Roux-en-Y Gastric Bypass (RYGB) has been considered a gold-standard procedure in the surgical treatment of morbid obesity. The linear stapled gastrojejunostomy (GJ) technique has proved to be safe and effective in long-term series of patients, but its optimal size referred to achieve best post-operative weight loss remains poorly understood. Aim: Evaluate the role of the linear-stapled GJ size in the mid-term postRYGB weight loss and occurrence of complications. Methods: From January to April 2014, 128 consecutive patients underwent to RYGB with linear stapled GJ and followed by to 2 years were included. The RYGB were carried out with the same technical steps, except by the length of the GJ. In GJ-15mm group (n=64), the GJ was constructed with white 45 mm cartridge in an extension of only 15 mm whereas in GJ-45mm group (n=64) the GJ was achieved using full extension of the cartridge. The weight loss reduction allowing evaluating the BMI was recorded at 1, 3, 6, 12, 18, and 24 months after procedure. Results: The mean age were 38±10.6 and 41.3±12.3 years (NS), and there were 45 (70.3%) and 51 (79.7%) females (NS) in GJ-15mm and GJ-45mm groups respectively. The analysis on raw BMI data showed that both groups had significant reduction of BMI over time (p≤0.05), however %BMI reduction was greater in GJ-15mm group from 18 months onwards (p≤0.05). Concerning the occurrence of complication was noticed just 1 case (1,56%) of GJ estenosis in the GJ-15mm. Conclusion: The global analysis of BMI reduction indicated that the narrower GJ represented a favoring factor reducing significantly more the BMI when compared to the wider GJ. Occurrence of complications was similar with just 1 case of GJ estenosis in the GJ15mm group.