title: Surgical standardization to prevent gastric stenosis after laparoscopic sleeve gastrectomy: a case series.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) is accepted as a stand-alone bariatric procedure. A specific and potentially severe complication of LSG is gastric stenosis (GS).
  
  
  OBJECTIVE
  Reviewing the treatment and prevention of GS after LSG.
  
  
  METHODS
  University hospital, Taiwan.
  
  
  METHODS
  A retrospective analysis was conducted involving all of the LSG cases (n = 927) at our institution between February 2007 and December 2015.
  
  
  RESULTS
  Eight patients (0.8%) with GS were identified in our unit and 1 patient was transferred from another institution with symptomatic GS. The median intervals from initial LSG to the presence of symptoms, endoscopic dilation, and surgical revision were 14±30 days (range, 7-103 days), 21±35.6 days (range, 9-110 days), and 36±473.9 days (range, 11-1185 days), respectively. The majority of stenoses were located at the incisura angularis (8/9 [88.9%]). Among the 9 patients, only 1 responded satisfactorily to repetitive endoscopic dilation and the remaining 8 patients required revisional laparoscopic surgery, including conversion to Roux-en-Y gastric bypass (n = 6), stricturoplasty (n = 1), and Roux-en-Y gastric bypass after failed seromyotomy (n = 1). No patients experienced recurrent symptoms of GS after revisional surgery. In September 2013, we modified our surgical techniques for the subsequent 489 patients and GS did not occur after the change in surgical procedures.
  
  
  CONCLUSIONS
  A combined treatment modality, endoscopic intervention with and without surgical revision is essential for managing GSs. Based on our own experience, we emphasize the clinical significance of surgical standardization to prevent the occurrence of GS.
authors.affiliation: Bariatric and Metabolic International Surgery Center, E-Da hospital/I-Shou University, Kaohsiung City, Taiwan; Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan; Weight Management Center, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors.forename: Po-Chih
authors.initials: PC
authors.lastname: Chang
authors.affiliation: Bariatric and Metabolic International Surgery Center, E-Da hospital/I-Shou University, Kaohsiung City, Taiwan; Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan.
authors.forename: Chi-Ming
authors.initials: CM
authors.lastname: Tai
authors.affiliation: Body Science and Metabolic Disorders International (BMI) Medical Center, China Medical University Hospital, Taichung City, Taiwan.
authors.forename: Ming-Che
authors.initials: MC
authors.lastname: Hsin
authors.affiliation: Division of General Surgery, Department of Surgery, E-Da Cancer Hospital/I-Shou University, Kaohsiung City, Taiwan.
authors.forename: Chao-Ming
authors.initials: CM
authors.lastname: Hung
authors.affiliation: Bariatric and Metabolic International Surgery Center, E-Da hospital/I-Shou University, Kaohsiung City, Taiwan; Weight Management Center, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors.forename: Ivy Ya-Wei
authors.initials: IY
authors.lastname: Huang
authors.affiliation: Body Science and Metabolic Disorders International (BMI) Medical Center, China Medical University Hospital, Taichung City, Taiwan. Electronic address: bmiscedah@gmail.com.
authors.forename: Chih-Kun
authors.initials: CK
authors.lastname: Huang
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000592:standards; D015992:Body Mass Index; D003251:Constriction, Pathologic / Q000517:prevention & control / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000592:standards; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000592:standards; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control / Q000601:surgery; D012015:Reference Standards; D012086:Reoperation; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000517:prevention & control* / Q000601:surgery
keywords: Bariatric surgery; Complications; Gastric stenosis; Laparoscopic sleeve gastrectomy