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Med Princ Pract. 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.

Author information

1
Department of Surgery, Kuwait University, Safat, Kuwait. falasfar@hsc.edu.kw

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.

PMID:
19648758
PMCID:
PMC2790757
DOI:
10.1159/000226289
[Indexed for MEDLINE]
Free PMC Article

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