Low anastomotic stricture rate after Roux-en-Y gastric bypass using a 21-mm circular stapling device.
BACKGROUND
Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been established as a safe and effective procedure for morbid obesity management. Amongst some of the postoperative complications are gastrojejunal (GJ) anastomotic strictures, with an incidence of 3 to 27 % in some series. This study evaluates the incidence of GJ strictures using a 21-mm circular stapling device and its response to treatment with endoscopic balloon dilation.


METHODS
A retrospective chart review was conducted of patients who underwent LRYGB between January 2007 and September 2010. We used our previously published technique of retrocolic, retrogastric Roux-en-Y bypass, using a 21-mm circular stapler to construct the gastrojejunostomy. Postoperatively, patients with persistent food intolerance underwent an endoscopy. Those found to have a GJ stricture (defined as inability to pass the endoscope beyond he anastomotic site) underwent pneumatic dilation with a 12-mm balloon.


RESULTS
A total of 338 patients underwent LRYGB. Median follow-up was 57.6 weeks (8-137). Twenty-two patients underwent an endoscopy due to food intolerance. Sixteen patients (4.7 %, 16/338) were identified with GJ stricture and received at least one endoscopic dilation. The other six patients had a normal endoscopic evaluation. GJ strictures presented at an average of 35 days (13 to 90 days) postoperatively. Four patients underwent two endoscopic interventions, and one underwent three endoscopic interventions.


CONCLUSIONS
We hereby demonstrate that the construction of GJ anastomosis with a 21-mm circular stapler is associated with a low stricture rate using our standardized technique. Strictures are amenable to balloon dilatation with subsequent long-term resolution of symptoms.
University of California at San Diego, San Diego, CA 92103, USA.
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A
Rondan
S
S
Nijhawan
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S
Majid
Tracy
T
Martinez
Alan C
AC
Wittgrove
D000328:Adult; D000368:Aged; D002404:Catheterization / Q000379:methods; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D004724:Endoscopy; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007583:Jejunum / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology* / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult