Linear versus Circular Stapler for Gastrojejunal Anastomosis in Laparoscopic Roux-En-Y Gastric Bypass: An Analysis of 211 Cases

Figure 1

Circular and linear stapler techniques for gastrojejunal anastomosis. (a) Roux-en-Y gastric bypass. CSA technique: (b) inserting the stapler head in the stomach before gastric pouch formation; (c) forming the gastric pouch and leading out the central rod from the pouch, inserting the circular stapler into the jejunal loop, and performing anastomosis. LSA technique: (d) after forming the stomach pouch, the jejunal loop is brought near and fixed with a holding thread, opening of the stomach pouch and the jejunal loop and introduction of the linear stacker, and preparation of the anastomosis; (e) closure of the opening for the stacker. GJA: gastrojejunal anastomosis, p: stomach pouch, s: residual stomach, b: biliary limb, a: alimentary limb, jj: jejunojejunostomy, and cc: common channel (the anastomosis was shown here once in front of and once behind the stapler suture row of the stomach pouch for simpler illustration).