Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass for morbid obesity.
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.
Goitein
D
D
Department of Surgery, The Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA, USA.
Papasavas
P K
PK
Gagné
D
D
Ahmad
S
S
Caushaj
P F
PF
D000328:Adult; D000368:Aged; D002404:Catheterization; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology; D004106:Dilatation; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods / Q000523:psychology; D006801:Humans; D007579:Jejunal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology / Q000601:surgery; D010535:Laparoscopy / Q000379:methods / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology / Q000601:surgery; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013272:Stomach Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology / Q000601:surgery; D013276:Stomach Ulcer / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000523:psychology / Q000601:surgery; D013528:Surgical Staplers; D013536:Suture Techniques; D016896:Treatment Outcome; D014456:Ulcer / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000523:psychology / Q000601:surgery; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology