Endoscopic dilation with Savary-Gilliard bougies of stomal strictures after laparosocopic gastric bypass in morbidly obese patients.
BACKGROUND
Anastomotic strictures after bariatric surgery are a frequent complication that requires endoscopic management, but the optimal technique for dilation remains to be determined. The aim of this study was to evaluate the safety and efficacy of dilation with Savary-Gilliard bougies (SGB) in morbidly obese patients treated with laparoscopic Roux-en-Y gastric bypass (RYGBP).


METHODS
Retrospective review of prospectively collected data from a series of 474 consecutive patients with laparoscopic bariatric surgery. Four-hundred twenty four of these patients (90%) underwent a laparoscopic RYGBP. A total of 24 patients were referred for anastomotic stricture dilation with SGB from January 1998 to December 2006.


RESULTS
A total of 24/424 patients (6%) developed a stricture that was successfully dilated with SGB. Patients were 17 females (71%) and seven males (29%) with a mean age of 41 +/- 11 years (range 24-63) and a mean BMI of 48 +/- 6 (range 40-69). The time between RYGBP and the appearance of stricture-related symptoms ranged from 29 to 154 days (mean, 69 days). The mean number of dilations was 1.6 +/- 0.6. The majority of patients required one (n = 11; 46%) or two (n = 12; 50%) dilations and only one patient required three dilations. During the initial dilation, a final diameter of 11 +/- 1.7 mm (range 7-12.8 mm) was achieved. In all cases, there was complete resolution of symptoms. There were no complications.


CONCLUSIONS
Dilation with SGB is an effective, safe, and durable method for managing anastomotic strictures after laparoscopic RYGBP.
Fernández-Esparrach
Glòria
G
Endoscopy Unit, Gastroenterology Department, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic, CIBER-ehd, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain. mgfernan@clinic.ub.es
Bordas
Josep M
JM
Llach
Josep
J
Lacy
Antonio
A
Delgado
Salva
S
Vidal
Josep
J
Cárdenas
Andrés
A
Pellisé
Maria
M
Ginès
Angels
A
Sendino
Oriol
O
Zabalza
Michel
M
Castells
Antoni
A
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D004106:Dilatation / Q000295:instrumentation*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007421:Intestine, Small / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*