Linear versus Circular Stapled Gastrojejunostomy in Minimally Invasive Roux-en-Y Gastric Bypass: A Nationwide Swiss Administrative Database Study (2015–2022)

BACKGROUND: The impact of stapling technique on early postoperative outcomes after minimally invasive Roux-en-Y gastric bypass (RYGB) remains incompletely understood. This study compared short-term postoperative outcomes following linear versus circular gastrojejunostomy. METHODS: This nationwide administrative database study included RYGB cases in Switzerland between 2015 and 2022. The primary endpoint was major in-hospital postoperative complication (composite of diagnoses and reoperation). Secondary endpoints included individual complications, length of hospital stay (LOS), and temporal trends in stapling technique. Associations were assessed using generalised additive regression models and propensity score matching (PSM). RESULTS: Among 21,320 RYGB cases, 18,161 (85.2%) underwent linear and 3,159 (14.8%) circular gastrojejunostomy. Circular stapling was not associated with major complication in multivariable analysis (OR = 1.221, 95% CI 0.824-1.809), whereas higher odds were observed after PSM (OR = 2.464, 95% CI 1.225-4.956). Circular stapling was associated with both surgical site infection (SSI) and LOS exceeding the 50th percentile in both multivariable (SSI: OR = 2.251, 95% CI 1.331-3.809; LOS: RR = 1.136, 95% CI 1.047-1.232) and PSM analyses (SSI: OR = 7.647, 95% CI 2.885-20.271; LOS: RR = 1.318, 95% CI 1.218-1.426). For LOS exceeding the 90th percentile, an association was observed in multivariable analysis (RR = 1.209, 95% CI 1.014-1.441), but not after PSM (RR = 1.018, 95% CI 0.604-1.715). Circular stapling decreased overall during the study period (Τ=-0.714, p = 0.013), despite year-to-year variation. CONCLUSION: The association between circular stapling and major in-hospital postoperative complication differed across analytical approaches. Associations with SSI and prolonged LOS were more consistent. Linear stapling increasingly predominated over time. Registry: ClinicalTrials.gov, TRN: NCT07483957, Registration date: 17 March 2026.