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Surgical Endoscopy
Published in: Surgical Endoscopy 3/2012

01-03-2012

Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese

Authors: Amit Parikh, Joshua B. Alley, Richard M. Peterson, Michael C. Harnisch, Jason M. Pfluke, Donovan M. Tapper, Stephen J. Fenton

Published in: Surgical Endoscopy | Issue 3/2012

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Abstract

Background

This study aimed to determine the incidence, etiology, and management options for symptomatic stenosis (SS) after laparoscopic sleeve gastrectomy (LSG).

Methods

A retrospective study reviewed morbidly obese patients who underwent LSG between October 2008 and December 2010 to identify patients treated for SS.

Results

In this study, 230 patients (83% female) with a mean age of 49.5 years and a mean body mass index (BMI) of 43 kg/m2 underwent LSG. In 3.5% of these patients (100% female; mean age, 42 years; mean BMI, 42.6 kg/m2), SS developed. The LSG procedure was performed using a 36-Fr. bougie and tissue-reinforced staplers. Four patients had segmental staple-line imbrication, and seven patients underwent contrast study, with 71.4% demonstrating a fixed narrowing. Endoscopy confirmed short-segment stenoses: seven located at mid-body and one located near the gastroesophageal junction. Endoscopic management was 100% successful. The mean number of dilations was 1.6, and the median balloon size was 15 mm. The mean time from surgery to initial endoscopic intervention was 48.8 days, and the mean time from the first dilation to toleration of a solid diet was 49.6 days. Two patients were referred to our institution after undergoing LSG at another facility. The mean time to the transfer was 28.5 days. The two patients had a mean age of 35 years and a mean BMI of 42.3 kg/m2. Both patients experienced immediate SS after perioperative complications comprising one staple-line hematoma and one leak. Contrast studies demonstrated minimal passage of contrast through a long-segment stenosis. Both patients underwent multiple endoscopic dilation procedures and endoluminal stenting, ultimately requiring laparoscopic conversion to Roux-en-Y gastric bypass. The mean time from the initial surgery to the surgical revision was 77 days, and the mean time after the first intervention to tolerance of a solid diet was 82 days.

Conclusion

Symptomatic short-segment stenoses after LSG may be treated successfully with endoscopic balloon dilation. Long-segment stenoses that do not respond to endoscopic techniques may ultimately require conversion to Roux-en-Y gastric bypass.
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Metadata
Title
Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese
Authors
Amit Parikh
Joshua B. Alley
Richard M. Peterson
Michael C. Harnisch
Jason M. Pfluke
Donovan M. Tapper
Stephen J. Fenton
Publication date
01-03-2012
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 3/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-011-1945-1

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