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Stricture Following Gastric Bypass and Vertical Sleeve Gastrectomy

  • Jacques Himpens
Chapter

Abstract

Stenosis or stricture is an abnormal narrowing of a passage or orifice in the body.

Stenosis after Roux-en-Y gastric bypass (RYGB) is most often located at the gastrojejunostomy and usually occurs early. The condition mostly responds well to dilation, with or without stents.

In case of failures, the laparoscopic reconstruction of the anastomosis is the treatment of choice.

Stenosis after sleeve gastrectomy usually occurs at the level of the incisura. Diagnosis is best performed by three-dimensional CT scan imaging. Treatment options include complex endoscopic balloon dilations, conversion to Roux-en-Y gastric bypass, seromyotomy, and resection of the stenotic segment with reanastomosis. The latter two options probably have poorer outcomes than conversion to bypass. In terms of prevention, peroperative gastroscopy and judicious choice of the intraluminal bougie are helpful.

In conclusion, stenosis may occur both after Roux-en-Y gastric bypass and after sleeve gastrectomy. Whereas the condition is rather benign after bypass because treatment usually is straightforward, it constitutes a quite severe issue after sleeve gastrectomy and may require sophisticated endoscopic means to successfully address it.

Keywords

Stenosis Stricture Roux-en-Y gastric bypass Gastrojejunostomy Sleeve gastrectomy Incisura Balloon dilations Conversion Seromyotomy Wedge resection 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jacques Himpens
    • 1
  1. 1.Department of G-I SurgerySt. Pierre University HospitalBrusselsBelgium

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