Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass |
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Authors: | Email author" target="_blank">Ninh?T?NguyenEmail author C?Melinda?Stevens Bruce?M?Wolfe |
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Institution: | (1) Department of Surgery, University of California, Irvine Medical Center, 101 City Dr., Building 55, Room 106, 92868 Orange, CA;(2) Department of Surgery, University of California, Davis Medical Center, Sacramento, California |
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Abstract: | Anastomotic stricture is a frequent complication after Roux-en-Y gastric bypass (GBP). We evaluated the frequency of anastomotic
stricture following laparoscopic GBP using a 21 mm. vs. a 25 mm circular stapler for construction of the gastrojejunostomy
and the safety and efficacy of endoscopic balloon dilation in the management of anastomotic stricture. We reviewed data on
29 patients in whom anastomotic strictures developed after laparoscopic GBP. All strictures were managed with endoscopic balloon
dilation using an 18 mm balloon catheter under fluoroscopic guidance. Main outcome measures were the number of anastomotic
strictures in patients in whom the 21 mm (vs. 25 mm) circular stapler was used to create the gastrojejunostomy, time interval
between the primary operation and symptoms, complications of endoscopic balloon dilation, the number of patients with resolution
of obstructive symptoms, and body weight loss. There were 28 females with a mean age of 39 years and a mean body mass index
of 48 kg/ m2. Anastomotic stricture occurred significantly more frequently with the use of the 21 mm compared to the 25 mm
circular stapler (26.8% vs. 8.8%, respectively; P<0.01). The median time interval between the primary operation and presentation
of stricture was 46 days. After the initial dilation, recurrent stricture developed in 5 (17.2%) of 29 patients. These five
patients underwent a second endoscopic dilation, and only one of these five patients required a third endoscopic dilation.
None of the 29 patients required more than three endoscopic dilations. The mean percentage of excess body weight loss at 1
year for patients in whom the 21 mm circular stapler was used for creation of the gastrojejunostomy was similar to that for
patients in whom the 25 mm circular stapler was used (68.2% vs. 70.2%, P = 0.8). In this series the rate of anastomotic stricture significantly decreased with the use of the 2 5 mm circular stapler
for construction of the gastrojejunostomy without compromising weight loss. Endoscopic balloon dilation is a safe and effective
option in the management of anastomotic stricture following laparoscopic GBP.
Presented at the Forty-Fourth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Florida, May 18–21,
2003. |
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Keywords: | Gastric bypass anastomotic stricture balloon dilation laparoscopy |
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