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

Surg Endosc. 2005 May;19(5):628-32. doi: 10.1007/s00464-004-9135-z. Epub 2005 Mar 11.

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.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Catheterization
  • Constriction, Pathologic / epidemiology
  • Constriction, Pathologic / etiology
  • Deglutition Disorders / epidemiology
  • Deglutition Disorders / etiology
  • Dilatation
  • Endoscopy, Gastrointestinal
  • Female
  • Follow-Up Studies
  • Gastric Bypass* / methods
  • Gastric Bypass* / psychology
  • Humans
  • Jejunal Diseases / diagnosis
  • Jejunal Diseases / epidemiology
  • Jejunal Diseases / etiology*
  • Jejunal Diseases / psychology
  • Jejunal Diseases / surgery
  • Laparoscopy* / methods
  • Laparoscopy* / psychology
  • Male
  • Middle Aged
  • Obesity, Morbid / surgery*
  • Patient Satisfaction
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology*
  • Postoperative Complications / psychology
  • Postoperative Complications / surgery
  • Retrospective Studies
  • Severity of Illness Index
  • Stomach Diseases / diagnosis
  • Stomach Diseases / epidemiology
  • Stomach Diseases / etiology*
  • Stomach Diseases / psychology
  • Stomach Diseases / surgery
  • Stomach Ulcer / diagnosis
  • Stomach Ulcer / epidemiology
  • Stomach Ulcer / etiology
  • Stomach Ulcer / psychology
  • Stomach Ulcer / surgery
  • Surgical Staplers
  • Suture Techniques
  • Treatment Outcome
  • Ulcer / diagnosis
  • Ulcer / epidemiology
  • Ulcer / etiology
  • Ulcer / psychology
  • Ulcer / surgery
  • Vomiting / epidemiology
  • Vomiting / etiology