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Refractory strictures after Roux-en-Y gastric bypass: operative management.
Surg Obes Relat Dis. 2011 Mar-Apr; 7(2):165-9.SO

Abstract

BACKGROUND

Stricture of the gastrojejunostomy after Roux-en-Y gastric bypass (RYGB) is common in the early postoperative period, with a reported incidence of 3-27%. Late recalcitrant strictures are much less common. Treatment has varied from endoscopic therapy to operative revision of the gastrojejunostomy with or without additional anatomic revisions. The origin of the late strictures varies, with the most common causes being excessive acid, aspirin, or nonsteroidal anti-inflammatory drug use, postoperative anastomotic leak, or, as some have maintained, smoking. We sought to identify the predictors of gastrojejunostomy strictures that require operative management after RYGB and to evaluate the clinical outcomes of patients requiring operative revision of the gastrojejunostomy stricture after failed nonoperative therapy at an academic institution.

METHODS

A retrospective review was performed of all patients undergoing operative intervention for gastrojejunostomy stricture from 1990 to 2009 after having undergone RYGB for medically complicated obesity.

RESULTS

A total of 24 patients required revision of their gastrojejunostomy stricture after multiple attempts at nonoperative therapy. The mean interval from RYGB to reoperation was 4.3 years (range .5-25). The interval to operative revision for anastomotic stricture was substantially less in patients with active anastomotic ulcers (n = 6), those who had had a gastrojejunostomy leak after RYGB (n = 5), and those with gastrogastric fistulas (n = 7; 20, 23, and 44 months, respectively). Of the 24 patients, 23 experienced relief of their symptoms. The postoperative morbidity rate was 21%, and the mortality rate was 0%.

CONCLUSION

Operative revision of strictured gastrojejunostomy is a safe and effective procedure for those patients in whom endoscopic therapy has failed. Most refractory anastomotic strictures have been secondary to excessive acid (too large a proximal pouch), chronic ulceration, or postoperative anastomotic leak.

Authors+Show Affiliations

Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

21195672

Citation

Cusati, Daniel, et al. "Refractory Strictures After Roux-en-Y Gastric Bypass: Operative Management." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 7, no. 2, 2011, pp. 165-9.
Cusati D, Sarr M, Kendrick M, et al. Refractory strictures after Roux-en-Y gastric bypass: operative management. Surg Obes Relat Dis. 2011;7(2):165-9.
Cusati, D., Sarr, M., Kendrick, M., Que, F., & Swain, J. M. (2011). Refractory strictures after Roux-en-Y gastric bypass: operative management. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 7(2), 165-9. https://doi.org/10.1016/j.soard.2010.11.003
Cusati D, et al. Refractory Strictures After Roux-en-Y Gastric Bypass: Operative Management. Surg Obes Relat Dis. 2011 Mar-Apr;7(2):165-9. PubMed PMID: 21195672.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Refractory strictures after Roux-en-Y gastric bypass: operative management. AU - Cusati,Daniel, AU - Sarr,Michael, AU - Kendrick,Michael, AU - Que,Florencia, AU - Swain,James M, Y1 - 2010/11/18/ PY - 2010/04/26/received PY - 2010/08/13/revised PY - 2010/11/05/accepted PY - 2011/1/4/entrez PY - 2011/1/5/pubmed PY - 2011/8/17/medline SP - 165 EP - 9 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 7 IS - 2 N2 - BACKGROUND: Stricture of the gastrojejunostomy after Roux-en-Y gastric bypass (RYGB) is common in the early postoperative period, with a reported incidence of 3-27%. Late recalcitrant strictures are much less common. Treatment has varied from endoscopic therapy to operative revision of the gastrojejunostomy with or without additional anatomic revisions. The origin of the late strictures varies, with the most common causes being excessive acid, aspirin, or nonsteroidal anti-inflammatory drug use, postoperative anastomotic leak, or, as some have maintained, smoking. We sought to identify the predictors of gastrojejunostomy strictures that require operative management after RYGB and to evaluate the clinical outcomes of patients requiring operative revision of the gastrojejunostomy stricture after failed nonoperative therapy at an academic institution. METHODS: A retrospective review was performed of all patients undergoing operative intervention for gastrojejunostomy stricture from 1990 to 2009 after having undergone RYGB for medically complicated obesity. RESULTS: A total of 24 patients required revision of their gastrojejunostomy stricture after multiple attempts at nonoperative therapy. The mean interval from RYGB to reoperation was 4.3 years (range .5-25). The interval to operative revision for anastomotic stricture was substantially less in patients with active anastomotic ulcers (n = 6), those who had had a gastrojejunostomy leak after RYGB (n = 5), and those with gastrogastric fistulas (n = 7; 20, 23, and 44 months, respectively). Of the 24 patients, 23 experienced relief of their symptoms. The postoperative morbidity rate was 21%, and the mortality rate was 0%. CONCLUSION: Operative revision of strictured gastrojejunostomy is a safe and effective procedure for those patients in whom endoscopic therapy has failed. Most refractory anastomotic strictures have been secondary to excessive acid (too large a proximal pouch), chronic ulceration, or postoperative anastomotic leak. SN - 1878-7533 UR - https://www.unboundmedicine.com/medline/citation/21195672/Refractory_strictures_after_Roux_en_Y_gastric_bypass:_operative_management_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(10)00752-5 DB - PRIME DP - Unbound Medicine ER -