Original article
Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y
gastric bypass surgery: analysis of 1291 patients
Lester Carrodeguas, M.D., Samuel Szomstein, M.D., Natan Zundel, M.D.,
Emanuel Lo Menzo, M.D., Ph.D., Raul Rosenthal, M.D.*
The Bariatric Institute, Cleveland Clinic Florida, Weston, Florida.
Manuscript received April 21, 2005; revised October 6, 2005; accepted October 18, 2005
Abstract Background: The development of an anastomotic stricture at the site of the gastrojejunostomy
following Roux-en-Y gastric bypass (RYGBP) is associated with substantial morbidity. Various
techniques are available for creating the gastrojejunal anastomosis, including hand-sewing and using
a circular or linear stapler, to reduce complication rates. The aim of this study was to assess the
incidence of gastrojejunal anastomotic strictures in patients who underwent antecolic antegastric
Roux-en-Y gastric bypass (AA-RYGBP) with the use of a linear stapler and to evaluate the
outcomes of endoscopic pneumatic dilatation as a treatment option for patients with anastomotic
stricture.
Methods: All patients who met the National Institutes of Health (NIH) criteria for bariatric surgery
and underwent AA-RYGBP using a linear stapler technique between July 2000 and November 2004
were included in the study. Following Institutional Review Board approval, the medical records of
these patients were retrospectively reviewed. Two surgeons performed all of the surgical procedures
in this series using a standardized surgical protocol.
Results: Between July 2000 and November 2004, 1291 patients (1016 females [79%] and 275 male
[11%]) underwent AA-RYGBP. The patients’ mean age was 43 years (range, 19 –75 years), and
mean preoperative body mass index (BMI) was 49.6 kg/m
2
(range, 34 –97.5 kg/m
2
). Out of 1291
procedures, 1265 were performed laparoscopically (98.3%), with the reminder performed by
laparotomy. A linear stapler was used to create the gastrojejunal anastomosis in all of the proce-
dures. A total of 405 (31%) complications occurred, with gastrojejunal anastomotic strictures the
most common complication, found in 94 (7.3%) patients more than 30 days after the procedure. All
of these cases of stricture were treated by endoscopic pneumatic dilatation with a through the scope
(TTS) balloon, requiring between one and four dilatory sessions. Of the 94 patients (2.1%) who
underwent balloon dilatation, 2 developed perforation, only 1 of whom required surgical interven-
tion. The mean postoperative hospital stay for the 94 patients was 4.2 days (range, 2–24 days); there
was no perioperative patient mortality.
Conclusions: Our results demonstrate that AA-RYGBP can attain a relatively low complication
rate and no mortality. Gastrojejunal anastomotic strictures were the most common complication and
were diagnosed 30 days after the procedure. Endoscopic balloon dilatation can be offered as a
first-line treatment for gastrojejunal anastomotic strictures. Perforation is a potential complication of
this treatment and may necessitate surgical intervention.
©
2006 American Society for Bariatric
Surgery. All rights reserved.
Keywords: Anastomotic stricture; Balloon dilatation; Obesity; Roux-en-Y gastric bypass
Presented at the 21st Annual Meeting of the American Society for
Bariatric Surgery, San Diego, California, June 12–18, 2004.
*Reprint requests: Raul Rosenthal, MD, Director, The Bariatric Insti-
tute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL
33331.
e-mail: rosentr@ccf.org
Surgery for Obesity and Related Diseases 2 (2006) 92–97
1550-7289/06/$ – see front matter © 2006 American Society for Bariatric Surgery. All rights reserved.
doi:10.1016/j.soard.2005.10.014