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Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass for morbid obesity

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Abstract

Background

Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass (LRYGBP) present with dysphagia, nausea, and vomiting. Diagnosis is made by endoscopy and/or radiographic studies. Therapeutic options include endoscopic dilation and surgical revision.

Methods

Of 369 LRYGBP performed, 19 patients developed anastomotic stricture (5.1%). One additional patient was referred from another facility. Pneumatic balloons were used for initial dilation in all patients. Savary-Gilliard bougies were used for some of the subsequent dilations.

Results

Flexible endoscopy was diagnostic in all 20 patients allowing dilation in 18 (90%). Two patients did not undergo endoscopic dilation because of anastomotic obstruction and ulcer. The median time to stricture development was 32 days (range: 17–85). Most patients (78%) required more than two dilations. The complication rate was 1.6% (one case of microperforation). At a mean follow-up of 21 months, all patients were symptom-free.

Conclusions

Gastrojejunostomy stricture following LRYGBP is associated with substantial morbidity and patient dissatisfaction. Based on our experience, we propose a clinical grading system and present our strategy for managing gastrojejunal strictures.

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Authors and Affiliations

  1. Department of Surgery, The Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA, USA

    D. Goitein, P. K. Papasavas, D. Gagné & P. F. Caushaj

  2. Department of Gastroenterology, The Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA

    S. Ahmad

Authors
  1. D. Goitein
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  2. P. K. Papasavas
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  3. D. Gagné
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  4. S. Ahmad
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  5. P. F. Caushaj
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Corresponding author

Correspondence to P. K. Papasavas.

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Goitein, D., Papasavas, P.K., Gagné, D. et al. Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc 19, 628–632 (2005). https://doi.org/10.1007/s00464-004-9135-z

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  • DOI: https://doi.org/10.1007/s00464-004-9135-z

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