title: Gastrojejunostomy stricture rate: comparison between antecolic and retrocolic laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Roux-en-Y gastric bypass procedure is an effective treatment for morbid obesity. One of the most frequent complications after this operation is the appearance of a gastrojejunal anastomotic stricture. Mechanisms underlying the development of such complication are unclear.
  
  
  OBJECTIVE
  The aim of the present retrospective study was to compare the rates of gastrojejunostomy stricture between the antecolic and retrocolic technique in a large cohort of patients undergoing Roux-en-Y gastric bypass for morbid obesity, with the same gastrojejunal anastomotic technique.
  
  
  METHODS
  University Hospital, France.
  
  
  METHODS
  From November 2000 to March 2012, 1500 patients underwent laparoscopic Roux-en-Y gastric bypass. The antecolic and the retrocolic technique were used in respectively 572 and 928 consecutive patients. All procedures were performed using a circular stapled gastrojejunostomy and absorbable sutures.
  
  
  RESULTS
  There was no significant difference with respect to gender, age, body mass index, and obesity related co-morbidities between both groups. Patients were followed for 24-146 months (mean 67.5 mo). Fifty-one patients developed a gastrojejunal stricture (3.4%), 37 in the antecolic group (6.5%) and 14 in the retrocolic group (1.5%). The difference was significant (P< .0001). The mean time to onset of gastrojejunal stricture symptoms after surgery was 1 month, ranging from 1 to 3 months. All patients were successfully treated using Savary-Gilliard dilatators. All patients with a gastrojejunal stricture were followed up for a minimum of 36 months. No recurrence was observed and no revisional surgery was needed. Weight loss was similar in patients who developed an anastomotic stricture compared with those without stricture. In the antecolic group internal hernia occurred in 12 of the 110 with no closure of mesenteric defects and in 8 of the 462 (1.7%) with defects closed. In the retrocolic group, 11 patients (1.2%) developed an internal hernia.
  
  
  CONCLUSIONS
  A significant lower gastrojejunal stricture rate was observed in the retrocolic group, with no increased risk of internal hernia, when mesenteric defects were closed. The antecolic technique seems to be a risk factor for gastrojejunal stricture development after laparoscopic gastric bypass.
authors.affiliation: Service de Chirurgie Générale et Digestive, Hôpital Bichat Claude Bernard, Paris, France. Electronic address: lara.parenti@me.com.
authors.forename: Lara
authors.initials: L
authors.lastname: Ribeiro-Parenti
authors.affiliation: Service de Chirurgie Générale et Digestive, Hôpital Bichat Claude Bernard, Paris, France.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Arapis
authors.affiliation: Service de Chirurgie Générale et Digestive, Hôpital Bichat Claude Bernard, Paris, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Chosidow
authors.affiliation: Service d'Endoscopie Digestive. Hôpital Privé des Peupliers, Paris, France.
authors.forename: Jean-Loup
authors.initials: JL
authors.lastname: Dumont
authors.affiliation: Service de d'Anesthésie Réanimation, Hôpital Bichat Claude Bernard, Paris, France.
authors.forename: Monique
authors.initials: M
authors.lastname: Demetriou
authors.affiliation: Service de Chirurgie Générale et Digestive, Hôpital Bichat Claude Bernard, Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Marmuse
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005602:France; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D012187:Retroperitoneal Space / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
keywords: Anastomotic complications; Bariatric surgery; Gastric bypass; Gastrojejunal strictures