Division of Bariatric Surgery of Diagnomed, Affiliated Institution of the University of Buenos Aires, Buenos Aires, Argentina.
J Laparoendosc Adv Surg Tech A. 2020 Aug;30(8):887-890. doi: 10.1089/lap.2020.0203. Epub 2020 Apr 29.
Gastric bypass is one of the most widely performed bariatric procedures worldwide and continues to be the gold standard in obese patients with metabolic disorders. Regarding the complications, these can appear early or late, the most frequent of the latter being anastomosis stenosis, especially the gastrojejunal (G-J) stenosis. The first treatment option in stenosis is the endoscopic approach, but in cases wherein it fails or the diagnosis is kinking, revisional surgery should be performed. We describe the technique, step by step, we use to perform a very complex revisional surgery in a patient with aphagia after gastric bypass. This is the case of a 38-year-old female patient who underwent laparoscopic adjustable gastric band in 2011; due to her poor tolerance, a laparoscopic gastric bypass was done. She began with vomiting and gastroesophageal reflux with remarkable symptoms. Diagnosis of stenosis of the jejunojejunal anastomosis of the Roux-en-Y was made and two surgeries were done to treat it. Later the patient referred aphagia and a kink of the gastrojejunal (G-J) anastomosis were observed in the gastrointestinal series. We decided to do a revisional surgery and we describe it step by step in this article. The G-J anastomosis stenosis is the most frequent late complication. Also kinking has to be considered strongly when aphagia or symptoms of obstruction are present. If endoscopic treatment for stenosis or cases of kinking is unsuccessful and fails, then revisional surgery should be considered.
胃旁路术是全球应用最广泛的减肥手术之一，并且仍然是代谢紊乱肥胖患者的金标准。关于并发症，它们可以是早期的也可以是晚期的，后者最常见的是吻合口狭窄，特别是胃空肠（G-J）吻合口狭窄。狭窄的首选治疗方法是内镜治疗，但如果内镜治疗失败或诊断为扭曲，应进行修正手术。我们描述了我们在一位胃旁路术后出现吞咽困难的患者中进行非常复杂的修正手术的技术，一步一步来。这是一位 38 岁女性患者的病例，她于 2011 年接受了腹腔镜可调胃带手术；由于她的耐受性差，进行了腹腔镜胃旁路手术。她开始出现呕吐和胃食管反流，症状明显。诊断为 Roux-en-Y 空肠空肠吻合口狭窄，并进行了两次手术来治疗。后来，患者出现吞咽困难，并在胃肠道系列检查中观察到胃空肠（G-J）吻合口扭曲。我们决定进行修正手术，并在本文中一步一步地描述它。G-J 吻合口狭窄是最常见的晚期并发症。如果存在吞咽困难或梗阻症状，也应强烈考虑扭曲。如果狭窄的内镜治疗或扭曲病例不成功或失败，则应考虑修正手术。
