Anastomotic Strictures After Roux-en-Y Gastric Bypass: a Cohort Study from the Scandinavian Obesity Surgery Registry
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).
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.
National bariatric surgery registry
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.
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%).
KeywordsMorbid obesity Bariatric surgery Endoscopy Stenosis Endoscopic dilation
The authors wish to acknowledge the surgical units at Aleris Skåne, Bariatric Center Skåne, Karlshamn, Borås, Capio S.t Göran, Carlanderska, Danderyd, Ersta, Falun, Gävle, Hudiksvall, Kalmar, Karolinska, Lund/Landskrona, Lycksele, Norrköping, Norrtälje, Sahlgrenska, Skövde, Sophiahemmet, Södersjukhuset, Varberg, Värnamo, Västerås, Örebro/Lindesberg, Östersund for contributing with patient details.
Compliance with Ethical Standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments. Informed consent has been obtained from all participants included in SOReg. The study was approved by the regional ethical review board in Uppsala (Dnr 2015/481).
Conflict of Interest
Kristina Almby has nothing to disclose. David Edholm received funding from Swedish medical council.