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Background: Laparoscopic Roux-en-Y gastric bypass is a wellpracticed surgical option for the treatment of morbid obesity. The aim of this study was to provide pooled analysis of individually small trials comparing 21mm versus 25mm circular stapled laparoscopic gastro-jejunal (GJ) anastomosis in morbid obesity surgery. Methods: A systematic literature search of Medline, Embase and Cochrane library databases was performed to identify all relevant studies comparing 21mm versus 25mm Circular stapled laparoscopic GJ anastomosis in morbid obesity surgery. Primary outcomes were gastro-jejunal stenosis and interval to GJ stenosis. Secondary outcomes were estimated weight loss, GJ diameter and number of endoscopic dilatations. Pooled odds ratios were calculated for categorical outcomes and weighted mean differences for continuous outcomes. Results: Five trials were included comprising 1,217 patients (393 with 21mm vs. 824 with 25mm Circular GJ anastomoses). Primary outcome analysis revealed significantly increased intra-luminal stenosis associated with the 21mm circular stapler (pooled odds ratio 3.54; P 0.0001). Secondary outcome analysis revealed a significantly reduced GJ anastomotic diameter on endoscopy with the 21mm Circular Stapler group (weighted mean difference -1.67; P 0.002). Statistical analysis revealed no significant difference between the groups for interval to stenosis, number of endoscopic dilatations and estimated weight loss. Conclusion: The results of this pooled analysis demonstrate significantly increased stenosis associated with the use of 21mm circular stapler compared with the 25mm. This serves as evidence to validate the preferential use of the 25mm circular stapler in laparoscopic gastro-jejunal bypass.