Endotherapy in unusual bariatric surgical complications (with videos).
Roux-en-Y gastric bypass (RYGBP) is the most commonly performed bariatric operation in the USA. We hypothesize that therapeutic endoscopy can be used to treat some unusual post-operative complications. We report two cases of early post-operative complications: (1) gastrogastrotomy (GG) stricture and (2) "trans-mesenteric tunnel" or "mesocolic" jejunal stricture. Endoscopic strictureplasty/revision of the gastric pouch of a bypass after gastroplasty was performed. The mesocolic stricture was managed with endoscopic dilatation using the achalasia dilating balloon under fluoroscopic and endoscopic guidance. With endotherapy, the patient with the GG stricture did not require re-operation, and there were no complications or stricture recurrence. The patient with mesocolic stricture responded short-term to endotherapy but ultimately required surgical adhesion lysis. None of these patients developed any procedure-related complications. Thus, in patients with unusual post-operative complications after RYGBP, endotherapy may be useful when there is good collaboration between the endoscopist and the surgeon.
Tang
Shou-jiang
SJ
Division of Digestive and Liver Diseases, Department of Internal Medicine, The UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9151, USA. shou-jiang.tang@utsouthwestern.edu
Tang
Linda
L
Jazrawi
Saad F
SF
Provost
David A
DA
D050110:Bariatric Surgery / Q000009:adverse effects*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007579:Jejunal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008646:Mesocolon; D008875:Middle Aged; D009767:Obesity, Morbid / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010532:Peritoneal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011859:Radiography; D012086:Reoperation; D013536:Suture Techniques; D000267:Tissue Adhesions / Q000175:diagnosis / Q000209:etiology / Q000601:surgery