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Anastomotic Strictures After Roux-en-Y Gastric Bypass: a Cohort Study from the Scandinavian Obesity Surgery Registry
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Akademiska Sjukhuset. (Jan Eriksson - Klinisk Diabetologi och metabolism)ORCID iD: 0000-0002-7083-8912
Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
2019 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 29, no 1, p. 172-177Article in journal (Refereed) Published
Abstract [en]

Background

Roux-en-Y gastric bypass (RYGB) is the most common bariatric procedure worldwide. Anastomotic stricture is a known complication of RYGB. The aim was to explore the incidence and outcomes of strictures within the Scandinavian Obesity Surgery Registry (SOReg).

Method

SOReg included prospective data from 36,362 patients undergoing bariatric surgery in the years 2007–2013. Outcomes were recorded at 30-day and at 1-year follow-up according to the standard SOReg routine. The medical charts of patients suffering from stricture after RYGB were requested and assessed.

Setting

National bariatric surgery registry

Results

Anastomotic stricture within 1 year of surgery was confirmed in 101 patients representing an incidence of 0.3%. Risk factors for stricture were patient age above 60 years (odds ratio (OR), 6.2 95% confidence interval (CI) 2.7–14.3), circular stapled gastrojejunostomy (OR 2.7, 95% CI 1.4–5.5), postoperative anastomotic leak (OR 8.9 95%, CI 4.7–17.0), and marginal ulcer (OR 30.0, 95% CI 19.2–47.0). Seventy-five percent of the strictures were diagnosed within 70 days of surgery. Two dilatations or less was sufficient to successfully treat 50% of patients. Ten pecent of patients developed perforation during dilatation, and the risk of perforating at each dilatation was 3.8%. Perforation required surgery in six cases but there was no mortality. Strictures in SOReg may be underreported, which could explain the low incidence in the study.

Conclusion

Most strictures present within 2 months and are successfully treated with two dilatations or less. Dilating a strictured gastrojejunostomy entails a risk of perforation (3.8%).

Place, publisher, year, edition, pages
New York City: Springer, 2019. Vol. 29, no 1, p. 172-177
Keywords [en]
Gastric bypass surgery, Obesity, Anastomosis, Stricture, Bariatric surgergy, SOReg, Endoscopy, Dilation
Keywords [sv]
Gastric bypass, övervikt, anastomos, striktur, bariatrisk kirurgi, överviktskirurgi, SOReg, endoskopi, dilatation
National Category
Surgery
Research subject
Medical Science; Surgery
Identifiers
URN: urn:nbn:se:uu:diva-374158DOI: 10.1007/s11695-018-3500-9ISI: 000454946800024PubMedID: 30206785OAI: oai:DiVA.org:uu-374158DiVA, id: diva2:1280202
Available from: 2019-01-18 Created: 2019-01-18 Last updated: 2019-02-04Bibliographically approved

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Almby, Kristina E.

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