Linear vs. Circular Stapled Gastrojejunal Anastomosis in Bariatric Laparoscopic Gastric Bypass Surgery in Switzerland

Linear vs. Circular Stapled Gastrojejunal Anastomosis in Bariatric Laparoscopic Gastric Bypass Surgery in Switzerland: A Retrospective National Registry Study From 2015 to 2022.

Bariatric surgery has become one of the preferred options in treatment of severe obesity and its comorbidities in the Western world. In Switzerland, the approximate 5000 annual bariatric operations are performed exclusively in centres certified by the "Swiss Society of Study of Morbid Obesity and Metabolic Disorders (SMOB)". Among the different bariatric surgical procedures, the laparoscopic gastric bypass remains one of the most frequently performed operations. A critical step of this operation is the creation of the gastrojejunal anastomosis. This can be done using either a linear or a circular stapler. The optimal method continues to be discussed in current academic research. The linear anastomosis technique seems to be more feasible, uses smaller incisions and is therefore faster performed. The circular anastomosis technique benefits from a standardised diameter of the anastomosis with consecutive higher reproducibility. No difference in long-term weight loss have been described for these two techniques until today. The linear technique has been linked to marginal ulcers, while the circular technique has been associated with higher rates of stenosis and incisional hernia. The associations with other long-term adverse events such as internal hernias remain under discussion. However, according to several international analyses, the linear technique seems to have favourable short-term outcomes with shorter operation time and lower rates of wound complications and postoperative bleeding. Both techniques are used in Switzerland but Swiss national data on this topic is scarce. Given the high annual case volume of bariatric surgery in Switzerland and the inconsistent international evidence, a systematic comparison of these two techniques is of relevance.

This retrospective registry study provides Swiss national data on short-term postoperative outcomes after elective laparoscopic Roux-en-Y gastric bypass from 2015 to 2022. It aims to compare the linear vs. circular gastrojejunal anastomosis in terms of postoperative short-term postoperative, reoperation rate, and length of hospital stay.

Study Overview

• Status: Completed
• Conditions: Bariatric Surgery (Gastric Bypass)
• Intervention / Treatment: Procedure: Linear anastomosis; Procedure: Circular anastomosis

• Study Type: Observational
• Enrollment (Actual): 21375

Contacts and Locations

Study Locations

• Switzerland
  • Sankt Gallen, Switzerland, 9000
    • HOCH Health Ostschweiz, Kantonsspital St.Gallen

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

All patients with gastric bypass surgery in Switzerland between 2015 and 2022

Description

Inclusion Criteria:

• Elective laparoscopic Roux-en-Y gastric bypass

Exclusion Criteria:

• Incomplete documentation
• Age under 20 years
• Other hospitals than general or surgical hospitals
• Omega-loop gastric bypass
• Emergency admission
• No stapler coded
• Open access

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Linear; Elective laparoscopic Roux-en-Y gastric bypass with linear gastrojejunal anastomsis	Procedure: Linear anastomosis; A linear stapled anastomosis was selected based on the Swiss Classification of Operations (CHOP) code 00.9A.13 or 00.9A.14.
Circular; Elective laparoscopic Roux-en-Y gastric bypass with circular gastrojejunal anastomsis	Procedure: Circular anastomosis; A circular stapled anastomosis was selected based on the Swiss Classification of Operations (CHOP) code 00.9A.11 or 00.9A.12.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Overall complications	Periprocedural

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Individual complications	International Statistical Classification of Diseases and Related Health Problems 10th Revision codes Myocardial infarction (I21, I22) I21, I22 Cardiac arrest I46 Arterial fibrillation I48 DVT and/or PE I26.0, I26.9, I80.2 Pneumonia J13-18, J85.1 Pleural effusion J90, J91 Atelectasis J98.1 Aspiration J69.0, J69.8, J95.4 Pulmonary insufficiency J95.1, J95.2, J95.3, J96 ARDS J80 Acute kidney injury N17, N19 Urinary tract infection N10, N30.0, N30.9, N39.0 Urinary retention R33 Anastomotic leakage K91.83 Gastrointestinal ulcer K25, K28 Peritonitis / abscess K65 Delayed gastric emptying K31.88 Ileus K56, K91.3 Bleeding K81.0, S36.81 Shock T81.1 Wound dehiscence T81.3 SSI T81.4, T89.02, L08.9 Intraoperative injury T81.2 Intraoperative retained foreign body T81.5, T81.6 Other complications J95.8, J95.9, K91.88, K91.9, T81.8, T81.9	Periprocedural
Reoperation	A reoperation was selected based on the Swiss Classification of Operations (CHOP) code 00.99.10.	Periprocedural
Length of hospital stay	Length of hospital stay was assessed at the 50th percentile (typical postoperative course) and the 90th percentile (prolonged postoperative course).	up to 4 weeks
Time trend age	Time trend of annual mean age (years)	Between 2015 and 2022
Time trend CCI	Time trend of annual mean Charlson Comorbidity Index (CCI)	Between 2015 and 2022
Time trend insurance	Time trend of annual percentage of private insurance	Between 2015 and 2022
Time trend access	Time trend of annual percentage of robotic access	Between 2015 and 2022

Collaborators and Investigators

• Sponsor: Cantonal Hospital of St. Gallen

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2015
• Primary Completion (Actual): December 31, 2022
• Study Completion (Actual): May 15, 2025

Study Registration Dates

• First Submitted: March 5, 2026
• First Submitted That Met QC Criteria: March 17, 2026
• First Posted (Actual): March 19, 2026

Study Record Updates

• Last Update Posted (Actual): March 19, 2026
• Last Update Submitted That Met QC Criteria: March 17, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: RYGB linear vs. circular

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No