Gastrojejunal Anastomotic Stenosis in Laparoscopic Gastric Bypass with a Circular Stapler (21 mm): Incidence, Treatment and Long-term Follow-up
- 195 Downloads
One of the keys to the long-term success of laparoscopic gastric bypass (LGBP) is performing a small-diameter gastrojejunal anastomosis, which occasionally involves an increased incidence of stenosis.
Between May 2000 and October 2008, 676 patients underwent LGBP with a no. 21 circular stapler to create the gastrojejunoanastomosis (GJA). We define stenosis when clinical symptoms suggest an obstruction and it is impossible to pass a 10-mm endoscope through the GJA. The treatment of patients with stenosis was endoscopic dilation with 10–15-mm balloons.
A total of 23 patients (3.4%) developed stenosis of whom 20 were females (3%) and three males (0.4%) with a mean age of 40.7 ± 11.6 years (range, 16–71 years) and a body mass index of 48.1 ± 6.9 kg/m2 (range, 34–78 kg/m2). The time between surgery and the onset of symptoms was 46.8 ± 24.5 days (range, 15–93 days). The stricture was resolved in all patients with endoscopic dilation: 18 patients with one dilation, three patients with two dilations and two patients with three dilations. There were no complications.
The incidence of gastrojejunal anastomotic stenosis in LGBP performed with a 21-mm circular stapler is low, and endoscopic dilation is an effective and complication-free treatment in 100% of cases.
KeywordsBariatric Surgery Obstructive Sleep Apnoea Gastric Pouch Circular Stapler Laparoscopic Gastric Bypass
- 23.Dresel A, Kuhn JA, Westmoreland MV, et al. Establishing a laparoscopic gastric bypass program. Am J Surg. 2002;179:476–81.Google Scholar
- 27.Champion JK. The route of Roux in laparoscopic gastric bypass—does it matter? Obes Surg. 2001;11:159. (Abst 17).Google Scholar
- 30.Wittgrove AC, Endres JE, Davis M, et al. Perioperative complications in a single surgeons experience with 1,000 consecutive laparoscopic Roux-en-Y gastric bypass operations for morbid obesity. Obes Surg. 2002;12:457–8.Google Scholar
- 32.McDonald KG, Pories WJ. Roux gastric bypass or vertical banded gastroplasty. Surgical treatment of morbid obesity. Prob Gen Surg. 1992;9:321–31.Google Scholar