Predicting Stricture in Morbidly Obese Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass: A Logistic Regression Analysis |
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Authors: | Robin P Blackstone Lisa A Rivera |
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Institution: | (1) Scottsdale Bariatric Center at Scottsdale Healthcare, 10200 N. 92nd Street, Suite 225, Scottsdale, AZ 85258, USA |
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Abstract: | Gastrojejunostomy stricture after Roux-en-Y gastric bypass occurs in 3 to 27% of morbidly obese patients in the USA. We questioned
whether preoperative patient characteristics, including demographic attributes and comorbid disease, might be significant
factors in the etiology of stricture. In this study from November 2001 to February 2006 (51 months), at a high-volume bariatric
center, of the 1,351 patients who underwent laparoscopic gastric bypass, 92 developed stricture (6.8%). All but two were treated
successfully by endoscopic dilation. All patients stopped nonsteroidal anti-inflammatory medications 2 weeks prior to surgery
and did not restart them. The operative procedure included the use of a 21-mm transoral circular stapler to create the gastrojejunostomy;
the Roux limb was brought retrogastric, retrocolic. In an effort to reduce our center’s stricture rate, late in the study,
U-clips used at the gastrojejunostomy were replaced by absorbable sutures, and postoperative H2 antagonists were added to the treatment protocol. The change to absorbable polyglactin suture proved to be significant, resulting
in a lower stricture rate. The addition of H2 antagonists showed no significant effect. Following the retrospective review of the prospective database, univariate and
multivariate logistic regression analyses identified factors associated with the development of stricture. Gastroesophageal
reflux disease and age were each shown to be statistically significant independent predictors of stricture following laparoscopic
gastric bypass.
Presented at the 2006 Annual Meeting of the Society for Surgery of the Alimentary Tract, May 20–24, Los Angeles, CA (poster
presentation). |
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Keywords: | Obesity Bariatric surgery Stricture Gastric bypass Gastrojejunostomy |
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