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Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass for morbid obesity

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Abstract

Background

Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass (LRYGBP) present with dysphagia, nausea, and vomiting. Diagnosis is made by endoscopy and/or radiographic studies. Therapeutic options include endoscopic dilation and surgical revision.

Methods

Of 369 LRYGBP performed, 19 patients developed anastomotic stricture (5.1%). One additional patient was referred from another facility. Pneumatic balloons were used for initial dilation in all patients. Savary-Gilliard bougies were used for some of the subsequent dilations.

Results

Flexible endoscopy was diagnostic in all 20 patients allowing dilation in 18 (90%). Two patients did not undergo endoscopic dilation because of anastomotic obstruction and ulcer. The median time to stricture development was 32 days (range: 17–85). Most patients (78%) required more than two dilations. The complication rate was 1.6% (one case of microperforation). At a mean follow-up of 21 months, all patients were symptom-free.

Conclusions

Gastrojejunostomy stricture following LRYGBP is associated with substantial morbidity and patient dissatisfaction. Based on our experience, we propose a clinical grading system and present our strategy for managing gastrojejunal strictures.

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Correspondence to P. K. Papasavas.

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Goitein, D., Papasavas, P.K., Gagné, D. et al. Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc 19, 628–632 (2005). https://doi.org/10.1007/s00464-004-9135-z

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Keywords

  • Gastric bypass
  • Strictures
  • Endoscopy
  • Dilation
  • Bariatric surgery
  • Morbid obesity.