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. 2009;18(5):364-7.
doi: 10.1159/000226289. Epub 2009 Jul 31.

Stricture rate after laparoscopic Roux-en-Y Gastric bypass with a 21-mm circular stapler: the Cleveland Clinic experience

Fahad Alasfar  1 , Adheesh A Sabnis, Rockson C Liu, Bipan Chand
Affiliations

Stricture rate after laparoscopic Roux-en-Y Gastric bypass with a 21-mm circular stapler: the Cleveland Clinic experience

Fahad Alasfar et al. Med Princ Pract. 2009.

Abstract

Objective: The objectives of this study were to report the incidence of gastrojejunal anastomic strictures that occurred in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery and to determine the time course of presentation, associated perioperative factors, and response to balloon dilation.

Subjects and methods: All 126 patients who underwent LRYGB at the Cleveland Clinic Foundation between July 2003 and February 2005 were included. We utilized a transoral 21-mm circular stapler for the gastrojejunostomy. Patients with symptoms of anastomotic strictures underwent upper endoscopy by one surgeon (B.C.). A stricture was defined by the inability to pass a 10-mm gastroscope through the anastomosis. Balloon dilation was performed to 12 mm. Records were analyzed retrospectively and statistical analysis including Pearson chi(2) statistics, Fisher's exact test and Student's t test were used when appropriate.

Results: Symptomatic anastomotic strictures occurred in 29 (23%) patients. All patients presented with nausea, vomiting and dysphagia. The median time to diagnosis was 52 days (25-309 days). Symptoms resolved after one dilation in 25 (86%) of patients. Two and three dilations were required in 1 (3.5%) and 3 (10.5%) of patients, respectively. No patients had complications or required more than 3 dilations. Age, preoperative body mass index (BMI), and intraoperative blood loss did not correlate with stricture formation. Although nonsteroidal anti-inflammatory drugs were used by 46 (41%) of patients after surgery, there was no correlation with stricture formation.

Conclusion: Symptomatic anastomotic strictures developed in nearly a quarter of patients who underwent LRYGB utilizing a transoral 21-mm circular stapled gastrojejunal anastomosis. A single endoscopic balloon dilation was usually adequate. Strictures were not predicted by perioperative factors.

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Figures

Fig. 1
Fig. 1
Gastrojejunostomy balloon dilation and the passage of the endoscope to the jejunum.
Fig. 2
Fig. 2
The gastrojejunostomy after dilation.
See this image and copyright information in PMC

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