Obesity Surgery

, Volume 29, Issue 1, pp 172–177 | Cite as

Anastomotic Strictures After Roux-en-Y Gastric Bypass: a Cohort Study from the Scandinavian Obesity Surgery Registry

  • Kristina Almby
  • David EdholmEmail author
Original Contributions



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%).


Morbid 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.


  1. 1.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.CrossRefGoogle Scholar
  2. 2.
    Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.CrossRefGoogle Scholar
  3. 3.
    Kolotkin RL, Crosby RD, Gress RE, et al. Two-year changes in health-related quality of life in gastric bypass patients compared with severely obese controls. Surg Obes Relat Dis. 2009;5(2):250–6.CrossRefGoogle Scholar
  4. 4.
    Da Costa M, Mata A, Espinós J, et al. Endoscopic dilation of gastrojejunal anastomotic strictures after laparoscopic gastric bypass. Predictors of initial failure. Obes Surg. 2011;21(1):36–41.CrossRefGoogle Scholar
  5. 5.
    Nguyen NT, Stevens CM, Wolfe BM. Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass. J Gastrointest Surg. 2003;7(8):997–1003.CrossRefGoogle Scholar
  6. 6.
    Edholm D, Sundbom M. Comparison between circular-and linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass—a cohort from the Scandinavian Obesity Registry. Surg Obes Relat Dis. 2015;11(6):1233–6.CrossRefGoogle Scholar
  7. 7.
    Azagury D, Dayyeh BA, Greenwalt I, et al. Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes. Endoscopy. 2011;43(11):950–4.CrossRefGoogle Scholar
  8. 8.
    Sverdén E, Mattsson F, Sondén A, et al. Risk factors for marginal ulcer after gastric bypass surgery for obesity: a population-based cohort study. Ann Surg. 2016;263(4):733–7.CrossRefGoogle Scholar
  9. 9.
    Rawlins L, Rawlins MP, Brown CC, et al. Effect of Helicobacter pylori on marginal ulcer and stomal stenosis after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2013;9(5):760–4.CrossRefGoogle Scholar
  10. 10.
    Ribeiro-Parenti L, Arapis K, Chosidow D, et al. Gastrojejunostomy stricture rate: comparison between antecolic and retrocolic laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2015;11(5):1076–84.CrossRefGoogle Scholar
  11. 11.
    Yimcharoen P, Heneghan H, Chand B, et al. Successful management of gastrojejunal strictures after gastric bypass: is timing important? Surg Obes Relat Dis. 2012;8(2):151–7.CrossRefGoogle Scholar
  12. 12.
    Hedenbro J, Näslund E, Boman L, et al. Formation of the Scandinavian Obesity Surgery Registry, SOReg. Obes Surg. 2015;25(10):1–8.CrossRefGoogle Scholar
  13. 13.
    Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefGoogle Scholar
  14. 14.
    Olbers T, Lönroth H, Fagevik-Olsén M, et al. Laparoscopic gastric bypass: development of technique, respiratory function, and long-term outcome. Obes Surg. 2003;13(3):364–70.CrossRefGoogle Scholar
  15. 15.
    Huang CS, Forse RA, Jacobson BC, et al. Endoscopic findings and their clinical correlations in patients with symptoms after gastric bypass surgery. Gastrointest Endosc. 2003;58(6):859–66.CrossRefGoogle Scholar
  16. 16.
    DeMaria EJ, Sugerman HJ, Meador JG, et al. High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg. 2001;233(6):809–18.CrossRefGoogle Scholar
  17. 17.
    Goitein D, Papasavas P, Gagne D, et al. Gastrojejunal strictures following laparoscopic oux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2005;19(5):628–32.CrossRefGoogle Scholar
  18. 18.
    Aghajani E, Jacobsen HJ, Nergaard BJ, et al. Internal hernia after gastric bypass: a new and simplified technique for laparoscopic primary closure of the mesenteric defects. J Gastrointest Surg. 2012;16(3):641–5.CrossRefGoogle Scholar
  19. 19.
    Vines L, Frick T, Aczél S, et al. Linear stapled gastrojejunostomy results in fewer strictures compared to circular stapled gastrojejunostomy in laparoscopic gastric bypass surgery. Langenbeck’s Arch Surg. 2017;402(6):911–6.CrossRefGoogle Scholar
  20. 20.
    Edholm D, Ottosson J, Sundbom M. Importance of pouch size in laparoscopic Roux-en-Y gastric bypass: a cohort study of 14,168 patients. Surg Endosc. 2016 May;30(5):2011–5.CrossRefGoogle Scholar
  21. 21.
    Mathew A, Veliuona MA, DePalma FJ, et al. Gastrojejunal stricture after gastric bypass and efficacy of endoscopic intervention. Dig Dis Sci. 2009;54(9):1971–8.CrossRefGoogle Scholar
  22. 22.
    Carrodeguas L, Szomstein S, Zundel N, et al. Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass surgery: analysis of 1291 patients. Surg Obes Relat Dis. 2006;2(2):92–7.CrossRefGoogle Scholar
  23. 23.
    de Moura EG, Orso IR, Aurélio EF, et al. Factors associated with complications or failure of endoscopic balloon dilation of anastomotic stricture secondary to Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis. 2016;12(3):582–6.CrossRefGoogle Scholar
  24. 24.
    Puig CA, Waked TM, Baron TH, et al. The role of endoscopic stents in the management of chronic anastomotic and staple line leaks and chronic strictures after bariatric surgery. Surg Obes Relat Dis. 2014;10(4):613–7.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institution of Medical SciencesUppsala UniversityUppsalaSweden
  2. 2.Department of Surgery and Department of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden

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