Routine management of stricture after gastric bypass and predictors of subsequent weight loss

Ryskina, Kira L.; Miller, Kenneth M.; Aisenberg, James; Herron, Daniel M.; Kini, Subhash

doi:10.1007/s00464-009-0605-1

Cited by 31 publications

(8 citation statements)

References 18 publications

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“…Of the 18 studies describing the method of anastomosis, 12 (70.5%) used a circular stapler and, five of them, also used either manual suturing 20,24 or a linear stapler 17,28,29 . Four studies used a linear stapler only 4,18,22,26 and one study used manual suturing only 11 .…”

Section: Resultsmentioning

confidence: 99%

“…Ryskina et al 24 reported that dilator type, and initial and maximum balloon size, were determined by the gastroenterologist at the time of the procedure. The literature did not establish a recommended time for dilation procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Review of the literature does not indicate the gold standard treatment for stricture. Since reoperation is rarely performed because of its complexity and the resulting morbidity, endoscopic dilation treatment seems to be a global trend 24,27 . Perugini et al found that more than half of the complications after RYGB in their series were due to anastomotic stricture, demonstrating the morbidity associated with this outcome 21 .…”

Section: Introductionmentioning

confidence: 99%

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Dilatação endoscópica de anastomose gastrojejunal após bypass gástrico

Campos

Mello

Ferraz

et al. 2012

ABCD, arq. bras. cir. dig.

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-Introduction -Roux-en-Y gastric bypass may result in stenosis of the gastrojejunal anastomosis. There is currently no well-defined management protocol for this complication. Aim -Through systematic review, to analyze the results of endoscopic dilation in patients with stenosis, including complication and success rates. Methods -The PubMed database was searched for relevant studies published each year from 1988 to 2010, and 23 studies were identified for analysis. Only papers describing the treatment of anastomotic stricture after Roux-en-Y gastric bypass were included, and case reports featuring less than three patients were excluded. Results -The mean age of the trial populations was 42.3 years and mean preoperative body mass index was 48.8 kg/m². A total of 1,298 procedures were undertaken in 760 patients (81% female), performing 1.7 dilations per patient. Through-the-scope balloons were used in 16 studies (69.5%) and Savary-Gilliard bougies in four. Only 2% of patients required surgical revision after dilation; the reported complication rate was 2.5% (n=19). Annual success rate was greater than 98% each year from 1992 to 2010, except for a 73% success rate in 2004. Seven studies reported complications, being perforation the most common, reported in 14 patients (1.82%) and requiring immediate operation in two patients. Other complications were also reported: one esophageal hematoma, one Mallory-Weiss tear, one case of severe nausea and vomiting, and two cases of severe abdominal pain. Conclusion -Endoscopic treatment of stenosis is safe and effective; however, further high-quality randomized controlled trials should be conducted to confirm these findings. ABCDDV/885RESUMO -Introdução -Bypass gástrico em Y-de-Roux pode resultar em estenose de anastomose gastrojejunal. Não há protocolo de tratamento bem definido para essa complicação. Objetivo -Analisar os resultados da dilatação endoscópica em pacientes com estenose, através de revisão sistemática, incluindo complicações e taxa de sucesso.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dilatação endoscópica de anastomose gastrojejunal após bypass gástrico

Campos

Mello

Ferraz

et al. 2012

ABCD, arq. bras. cir. dig.

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“…In the current era of divided RYGB, the majority of GGF are caused by poor surgical technique with failure to completely divide the stomach during pouch creation with maintenance of continuity between the pouch and remnant. In order to reduce the incidence of GGF some authors recommend a meticulous oversewing of staple lines, careful anastomotic technique with good bites of healthy tissue, avoidance of alimentary limb obstruction, and intraoperative confirmation of anastomosis integrity using methylene blue 34 .…”

Section: Methodsmentioning

confidence: 99%

Late surgical complications after gastric by-pass: a literature review

Palermo

Acquafresca

Rogula

et al. 2015

ABCD, arq. bras. cir. dig.

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IntroductionGastric bypass is today the most frequently performed bariatric procedure, but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the late ones.MethodLiterature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English.ResultsThere were selected 35 studies that matched the headings. Late complications were considered as: anastomotic strictures, marginal ulceration and gastrogastric fistula.ConclusionKnowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention.

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“…Sequential balloon dilatation of a stricture is effective in restoring an adequate gastric outlet size, often over the course of multiple treatments . Expert gastrointestinal consultation is vital, and possibly surgical consultation.…”

Section: Casesmentioning

confidence: 99%