Gastrojejunal strictures after Roux-en-Y gastric bypass with a 21-MM circular stapler.
BACKGROUND
Intraluminal staplers for gastrojejunostomy construction during Roux-en-Y gastric bypass (RYGBP) may be associated with postoperative strictures. We analyzed outcomes of a transabdominal circular-stapled RYGBP with evaluation of short- and long-term anastomotic complications.


METHODS
All laparoscopic RYGBPs performed between January 2004 and December 2005 at an academic institution were reviewed. The gastrojejunostomy was created by using the transabdominal passage of a 21-mm intraluminal circular stapler into an antecolic, antegastric Roux limb. This retrospective chart review analyzes patient demographics, anastomotic complications, and weight loss.


RESULTS
Between January 2004 and December 2005, 159 patients underwent transabdominal circular-stapled RYGBP. Fifteen patients developed a stenosis at the gastrojejunostomy, all requiring endoscopic balloon dilatation. One of these patients required laparoscopic revision of the gastrojejunostomy. Eleven strictures occurred after 30 days, whereas only 4 strictures occurred within 30 days of surgery. Two marginal ulcerations were seen within 1 year of surgery.


CONCLUSIONS
Our 9.4% stricture rate parallels what has been reported in the literature. The majority of strictures were amenable to one endoscopic treatment session. Transabdominal circular-stapled gastrojejunostomy is a reproducible construct for use in bariatric surgery.
Dolce
Charles J
CJ
Albany Medical College, Department of Surgery, New York, USA. charles.dolce@carolinashealthcare.org
Dunnican
Ward J
WJ
Kushnir
Leon
L
Bendana
Emma
E
Ata
Ashar
A
Singh
T Paul
TP
D000328:Adult; D000713:Anastomosis, Roux-en-Y; D002404:Catheterization; D003251:Constriction, Pathologic; D005260:Female; D015390:Gastric Bypass / Q000295:instrumentation*; D006801:Humans; D007579:Jejunal Diseases / Q000209:etiology / Q000628:therapy*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D013528:Surgical Staplers; D016896:Treatment Outcome; D015431:Weight Loss