Linear versus Circular Stapled Gastrojejunostomy in Minimally Invasive Roux-en-Y Gastric Bypass: A nationwide Swiss Registry study (2015-2022)

<title>Abstract</title> <p> <bold>Background</bold> The impact of stapling technique on early postoperative outcomes in minimal invasive Roux-en-Y gastric bypass (RYGB) remains incompletely understood. This study aimed to compare short-term postoperative outcomes following linear versus circular gastrojejunostomy. <bold>Methods</bold> This retrospective population-based study analysed data from the Swiss national inpatient registry between 2015 and 2022. The primary endpoint was overall postoperative complications. Secondary endpoints were individual postoperative complications, reoperation, and length of hospital stay (LOS). Associations between stapling technique and postoperative outcomes were assessed using generalized additive regression models. <bold>Results</bold> A total of 21,375 cases were included. Of these, 18,202 cases (85.2%) underwent a linear whereas 3,173 (14.8%) underwent a circular gastrojejunostomy. The overall complication rate was 8.1% (n = 1,724). Stapling technique was not associated with overall postoperative complications (odds ratio [OR] for circular vs. linear = 1.087, p = 0.238) or reoperation (OR = 1.043, p = 0.691). Compared with linear, circular stapling was associated with higher rates of surgical site infection (OR = 2.330, p &lt; 0.001), urinary tract infection (OR = 1.643, p = 0.041), urinary retention (OR = 1.729, p = 0.010), ICU admission (OR = 2.650, p &lt; 0.001), and prolonged LOS both at the 50th percentile (3 days, OR = 1.103, p = 0.019) as well as at the 90th percentile (5 days, p = 0.005). Secondary RYGB procedures were associated with the highest risk of overall complications (OR = 2.955, p &lt; 0.001). <bold>Conclusion</bold> Neither linear nor circular stapling demonstrated clear superiority. However, circular stapling was associated with higher rates of several specific postoperative complications and prolonged LOS. Secondary RYGB procedures carried a substantially increased risk of postoperative complications. Registry: ClinicalTrials.gov, TRN: NCT07483957, Registration date: 17 March 2026. </p>