Endoscopic Dilation with Savary-Gilliard Bougies of Stomal Strictures After Laparosocopic Gastric Bypass in Morbidly Obese Patients |
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Authors: | Glòria Fernández-Esparrach Josep M Bordas Josep Llach Antonio Lacy Salva Delgado Josep Vidal Andrés Cárdenas Maria Pellisé Angels Ginès Oriol Sendino Michel Zabalza Antoni Castells |
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Institution: | (1) Endoscopy Unit, Gastroenterology Department, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic, CIBER-ehd, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain;(2) Gastrointestinal Surgery Unit, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic, CIBER-ehd, IDIBAPS, University of Barcelona, Barcelona, Spain;(3) Endocrinology Department, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic, CIBER-ehd, IDIBAPS, University of Barcelona, Barcelona, Spain |
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Abstract: | Background Anastomotic strictures after bariatric surgery are a frequent complication that requires endoscopic management, but the optimal
technique for dilation remains to be determined. The aim of this study was to evaluate the safety and efficacy of dilation
with Savary–Gilliard bougies (SGB) in morbidly obese patients treated with laparoscopic Roux-en-Y gastric bypass (RYGBP).
Patients and Methods Retrospective review of prospectively collected data from a series of 474 consecutive patients with laparoscopic bariatric
surgery. Four-hundred twenty four of these patients (90%) underwent a laparoscopic RYGBP. A total of 24 patients were referred
for anastomotic stricture dilation with SGB from January 1998 to December 2006.
Results A total of 24/424 patients (6%) developed a stricture that was successfully dilated with SGB. Patients were 17 females (71%)
and seven males (29%) with a mean age of 41 ± 11 years (range 24–63) and a mean BMI of 48 ± 6 (range 40–69). The time between
RYGBP and the appearance of stricture-related symptoms ranged from 29 to 154 days (mean, 69 days). The mean number of dilations
was 1.6 ± 0.6. The majority of patients required one (n = 11; 46%) or two (n = 12; 50%) dilations and only one patient required three dilations. During the initial dilation, a final diameter of 11 ± 1.7 mm
(range 7–12.8 mm) was achieved. In all cases, there was complete resolution of symptoms. There were no complications.
Conclusions Dilation with SGB is an effective, safe, and durable method for managing anastomotic strictures after laparoscopic RYGBP.
Presented at the 12th World Congress of the International Federation for the Surgery of Obesity, Porto, Portugal, September
7, 2007. |
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Keywords: | Morbid obesity Bariatric surgery Stomal stricture Endoscopic dilation Bougies |
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