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Stricture rate after laparoscopic Roux-en-Y Gastric bypass with a 21-mm circular stapler: the Cleveland Clinic experience.
Med Princ Pract. 2009; 18(5):364-7.MP

Abstract

OBJECTIVE

The objectives of this study were to report the incidence of gastrojejunal anastomic strictures that occurred in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery and to determine the time course of presentation, associated perioperative factors, and response to balloon dilation.

SUBJECTS AND METHODS

All 126 patients who underwent LRYGB at the Cleveland Clinic Foundation between July 2003 and February 2005 were included. We utilized a transoral 21-mm circular stapler for the gastrojejunostomy. Patients with symptoms of anastomotic strictures underwent upper endoscopy by one surgeon (B.C.). A stricture was defined by the inability to pass a 10-mm gastroscope through the anastomosis. Balloon dilation was performed to 12 mm. Records were analyzed retrospectively and statistical analysis including Pearson chi(2) statistics, Fisher's exact test and Student's t test were used when appropriate.

RESULTS

Symptomatic anastomotic strictures occurred in 29 (23%) patients. All patients presented with nausea, vomiting and dysphagia. The median time to diagnosis was 52 days (25-309 days). Symptoms resolved after one dilation in 25 (86%) of patients. Two and three dilations were required in 1 (3.5%) and 3 (10.5%) of patients, respectively. No patients had complications or required more than 3 dilations. Age, preoperative body mass index (BMI), and intraoperative blood loss did not correlate with stricture formation. Although nonsteroidal anti-inflammatory drugs were used by 46 (41%) of patients after surgery, there was no correlation with stricture formation.

CONCLUSION

Symptomatic anastomotic strictures developed in nearly a quarter of patients who underwent LRYGB utilizing a transoral 21-mm circular stapled gastrojejunal anastomosis. A single endoscopic balloon dilation was usually adequate. Strictures were not predicted by perioperative factors.

Authors+Show Affiliations

Department of Surgery, Kuwait University, Safat, Kuwait. falasfar@hsc.edu.kwNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19648758

Citation

Alasfar, Fahad, et al. "Stricture Rate After Laparoscopic Roux-en-Y Gastric Bypass With a 21-mm Circular Stapler: the Cleveland Clinic Experience." Medical Principles and Practice : International Journal of the Kuwait University, Health Science Centre, vol. 18, no. 5, 2009, pp. 364-7.
Alasfar F, Sabnis AA, Liu RC, et al. Stricture rate after laparoscopic Roux-en-Y Gastric bypass with a 21-mm circular stapler: the Cleveland Clinic experience. Med Princ Pract. 2009;18(5):364-7.
Alasfar, F., Sabnis, A. A., Liu, R. C., & Chand, B. (2009). Stricture rate after laparoscopic Roux-en-Y Gastric bypass with a 21-mm circular stapler: the Cleveland Clinic experience. Medical Principles and Practice : International Journal of the Kuwait University, Health Science Centre, 18(5), 364-7. https://doi.org/10.1159/000226289
Alasfar F, et al. Stricture Rate After Laparoscopic Roux-en-Y Gastric Bypass With a 21-mm Circular Stapler: the Cleveland Clinic Experience. Med Princ Pract. 2009;18(5):364-7. PubMed PMID: 19648758.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stricture rate after laparoscopic Roux-en-Y Gastric bypass with a 21-mm circular stapler: the Cleveland Clinic experience. AU - Alasfar,Fahad, AU - Sabnis,Adheesh A, AU - Liu,Rockson C, AU - Chand,Bipan, Y1 - 2009/07/31/ PY - 2008/06/25/received PY - 2008/10/07/accepted PY - 2009/8/4/entrez PY - 2009/8/4/pubmed PY - 2009/10/29/medline SP - 364 EP - 7 JF - Medical principles and practice : international journal of the Kuwait University, Health Science Centre JO - Med Princ Pract VL - 18 IS - 5 N2 - OBJECTIVE: The objectives of this study were to report the incidence of gastrojejunal anastomic strictures that occurred in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery and to determine the time course of presentation, associated perioperative factors, and response to balloon dilation. SUBJECTS AND METHODS: All 126 patients who underwent LRYGB at the Cleveland Clinic Foundation between July 2003 and February 2005 were included. We utilized a transoral 21-mm circular stapler for the gastrojejunostomy. Patients with symptoms of anastomotic strictures underwent upper endoscopy by one surgeon (B.C.). A stricture was defined by the inability to pass a 10-mm gastroscope through the anastomosis. Balloon dilation was performed to 12 mm. Records were analyzed retrospectively and statistical analysis including Pearson chi(2) statistics, Fisher's exact test and Student's t test were used when appropriate. RESULTS: Symptomatic anastomotic strictures occurred in 29 (23%) patients. All patients presented with nausea, vomiting and dysphagia. The median time to diagnosis was 52 days (25-309 days). Symptoms resolved after one dilation in 25 (86%) of patients. Two and three dilations were required in 1 (3.5%) and 3 (10.5%) of patients, respectively. No patients had complications or required more than 3 dilations. Age, preoperative body mass index (BMI), and intraoperative blood loss did not correlate with stricture formation. Although nonsteroidal anti-inflammatory drugs were used by 46 (41%) of patients after surgery, there was no correlation with stricture formation. CONCLUSION: Symptomatic anastomotic strictures developed in nearly a quarter of patients who underwent LRYGB utilizing a transoral 21-mm circular stapled gastrojejunal anastomosis. A single endoscopic balloon dilation was usually adequate. Strictures were not predicted by perioperative factors. SN - 1423-0151 UR - https://www.unboundmedicine.com/medline/citation/19648758/Stricture_rate_after_laparoscopic_Roux_en_Y_Gastric_bypass_with_a_21_mm_circular_stapler:_the_Cleveland_Clinic_experience_ L2 - https://www.karger.com?DOI=10.1159/000226289 DB - PRIME DP - Unbound Medicine ER -