Gastrojejunal anastomotic stricture after Roux-en-Y gastric bypass: ambulatory management with the Savary-Gilliard dilator.
BACKGROUND
Roux-en-Y gastric bypass (RYGBP) is currently one of the most frequently performed procedures for the surgical treatment of morbid obesity. The success of this procedure's restrictive component requires a small gastrojejunostomy (GJ), which occasionally results in stenosis. The treatment of choice for this complication is balloon dilation. This study aimed to evaluate the feasibility and safety of ambulatory management for stenosis of the GJ using endoscopically guided Savary-Gilliard dilators.


METHODS
Between January 1998 and October 2003, 769 patients underwent RYGBP. The mean age of these patients was 38 +/- 12 years, and their mean body mass index (BMI) was 43 +/- 6 kg/m2. Of these 769 patients, 520 (68%) underwent open surgery and 249 (32%) underwent laparoscopic RYGBP. Patients suspected of GJ stenosis were referred for upper gastrointestinal endoscopy. Those who presented with stenosis were managed endoscopically with Savary-Gilliard dilators.


RESULTS
Stenosis at the GJ was confirmed in 53 patients (6.9%). A total of 71 dilations were performed for these patients, resulting in a mean of 1.3 dilations per patient. One dilation was needed for 41 patients (75.5%), two dilations for 9 patients (16.9%), three dilations for 3 patients (5.7%), and four dilations 1 patient (1.9%). The patients subjected to open RYGBP required a mean of 1.57 dilations, and those who had laparoscopic RYGBP required mean of 1.08 dilations. The mean time for the first dilation was 51 +/- 28 days after surgery (range, 20-178 days). All the dilations were performed in ambulatory settings. One patient (1.9%) was admitted after GJ dilation for pain. He was discharged without symptoms after 2 days with no need for invasive procedures.


CONCLUSIONS
The management and treatment of GJ stenosis after RYGBP can be effectively accomplished in ambulatory settings using endoscopically guided Savary-Gilliard dilators, with good and safe results.
Escalona
A
A
Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile. aescalon@puc.cl
Devaud
N
N
Boza
C
C
Pérez
G
G
Fernández
J
J
Ibáñez
L
L
Guzmán
S
S
D000328:Adult; D000553:Ambulatory Care; D002404:Catheterization / Q000009:adverse effects; D003251:Constriction, Pathologic; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D005774:Gastrostomy / Q000009:adverse effects; D006801:Humans; D007579:Jejunal Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D007582:Jejunostomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D013272:Stomach Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*