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Laparoscopic Seromyotomy for Long Stenosis After Sleeve Gastrectomy with or Without Duodenal Switch

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Abstract

Background

Sleeve gastrectomy (SG) can be performed either as isolated (ISG), or with the malabsorptive procedure of duodenal switch (SG/DS). Among the postoperative complications, stenosis of the SG is relatively rare and only scarcely mentioned in literature. We report our experience in nine patients presenting a long stenosis, not eligible for endoscopic balloon dilation, and treated by laparoscopic seromyotomy after ISG or SG/DS.

Methods

From March 2006 to January 2008, four patients after ISG (0.7%) and five patients after SG/DS (0.8%) were consecutively submitted to laparoscopic seromyotomy for long stenosis, not eligible for endoscopic balloon dilation. Dysphagia appeared after a mean time of 9.2 ± 2.6 months (ISG) and of 18.6 ± 13.2 months (SG/DS). Preoperative mean dysphagia frequency was 4 ± 0 (ISG) and 4 ± 0 (SG/DS). Gastroesophageal reflux disease (GERD) symptoms appeared as de novo in two patients of both groups. Barium swallow showed a stenosis at the upper part of the SG (2) and at the level of the incisura angularis (7). Gastroscopy evidenced a mean length of the stricture of 4.7 ± 0.9 cm (ISG) and of 5.2 ± 1.3 cm (SG/DS). The primary outcomes measure was stricture healing rate. Secondary outcomes measures included procedure time, peroperative, and postoperative complications, performance of barium swallow check, and GERD symptoms improvement.

Results

There were no conversions to open surgery and no mortality. There was no peroperative gastric perforation, but one patient was converted into Roux-en-Y gastric bypass (ISG). Mean operative time was 153.7 ± 39.4 min (ISG) and 110 ± 6.1 min (SG/DS). One gastric leak was recorded postoperatively (ISG). Mean hospital stay was 7.6 ± 5.8 days (ISG) and 3.4 ± 0.8 days (SG/DS). Barium swallow check after 1 month was satisfied in all patients, and they were able to tolerate a regular diet. After a mean follow-up of 21 ± 5.6 months (ISG), the mean dysphagia score was reduced to 0.6 ± 0.9, and after a mean follow-up of 17.6 ± 10.5 months (SG/DS) to 0.8 ± 0.8. De novo GERD symptoms improved in two patients of both groups.

Conclusion

Laparoscopic seromyotomy after SG for long stenosis is feasible, and efficient for the treatment of symptomatic dysphagia. It has a beneficiary influence on de novo GERD symptoms improvement. There is, however, the risk of postoperative leak.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, 322 rue Haute, 1000, Brussels, Belgium

    Giovanni Dapri, Guy Bernard Cadière & Jacques Himpens

Authors
  1. Giovanni Dapri
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  2. Guy Bernard Cadière
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  3. Jacques Himpens
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Corresponding author

Correspondence to Giovanni Dapri.

Additional information

This paper has been presented at the XIII World Congress of International Federation for the Surgery of Obesity and Metabolic Disorders, Buenos Aires, September 24–27, 2008.

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Dapri, G., Cadière, G.B. & Himpens, J. Laparoscopic Seromyotomy for Long Stenosis After Sleeve Gastrectomy with or Without Duodenal Switch. OBES SURG 19, 495–499 (2009). https://doi.org/10.1007/s11695-009-9803-0

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