Stenosis of the gastroenterostomy after laparoscopic gastric bypass.

BACKGROUND

Stenosis of the gastroenterostomy after laparoscopic Roux-en-Y gastric bypass (LRYGBP) is a serious problem that occurs after stapled (linear or circular) and hand-sewn anastomoses.

METHODS

Data was prospectively entered into a database to track complications of bariatric surgery. Between Feb 27, 1999 and June 13, 2000, 1000 patients underwent LRYGBP. All patients met NIH criteria for bariatric surgery.The gastroenterostomy was constructed with a linear stapler inserted to 20 mm (15 mm cut). The stapler defect was closed with a polyester running suture to construct a 12-mm diameter anastomosis. The anastomosis was banded with fascia lata to prevent late enlargement. All patients with suspected stenosis were endoscoped.

RESULTS

32 patients (3.2%) developed stenosis (<10 mm diameter orifice) at the gastroenterostomy. There were 27 females. Average age was 44.8. Average BMI was 45.0. Average stenotic orifice was 5.7 mm in diameter. Stenoses occurred in 18 of 32 patients (56.3%) by 3 months, 26 (81.3%) by 6 months, and 31 (96.9%) by 1 year. 30 of the 32 patients underwent endoscopic dilation as initial therapy. 17 of the 32 underwent multiple dilations. Dilation caused 4 perforations, resulting in 2 emergency operations. Perforation occurred at the first attempt at dilation in 3 of 4 patients. Stenoses could not be successfully dilated in 8 patients, and all 8 underwent surgical revision. There were no deaths in these 32 patients, but there were 68 dilations and 10 re-operations.

CONCLUSION

Stenosis of the gastroenterostomy after LRYGBP is an infrequent but serious problem, which results in considerable morbidity.