Abstract
Introduction
Laparoscopic sleeve gastrectomy (LSG) is becoming an increasingly popular form of bariatric surgery, accounting for more than 50% of these procedures performed in the USA. Given this popularity, more is being understood about the complications associated with LSG, which, though uncommon, include the formation of strictures and stenosis. The purpose of this study is to establish a safe and effective protocol for the treatment of stenosis post-LSG using endoscopic balloon dilatation.
Materials and methods
This is a prospective review of 26 patients who had undergone LSG in Kuwait, followed by sleeve gastrectomy stenosis (SGS) and were then referred to Amiri Hospital for endoscopic balloon dilatation from October 2008 up to June 2016.
Results
A total of 26 patients (four males; 22 females) presented with symptoms of stenosis post-LSG during the study period. The mean age of the patients was 34.6 ± 10.8 years. The mean body mass index at the time of surgery was 43 ± 1.6 kg/m2. The median interval from the initial LSG surgery was 95 days. Nine patients had an early presentation (≤3 months from surgery), while 17 presented late (>3 months). The patients were followed for a mean duration of 156 ± 20 days from the last endoscopic balloon dilatation. A total of 23 (88.5%) patients had complete resolution of their symptoms. Adverse events were observed in one patients, who was removed from the study.
Conclusions
Gastric stenosis is a rare but potentially serious complication of LSG. Serial dilatation of SGS employing endoscopic balloons is a safe method of treatment, with high efficacy rates. This new method may offer a less invasive alternative to surgical revision. However, if endoscopic treatment fails, surgery is necessary.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Change history
19 May 2017
An erratum to this article has been published.
References
Ng M, Fleming T, Robinson M et al (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of disease study 2013. The Lancet 384(9945):766–781
Al Rashdan I, Al Nesef Y (2009) Prevalence of overweight, obesity, and metabolic syndrome among adult kuwaitis: results from community-based national survey. Angiology 61(1):42–48
Khorgami Z, Andalib A, Corcelles R, Aminian A, Brethauer S, Schauer P (2015) recent national trends in the surgical treatment of obesity: sleeve gastrectomy dominates. Surg Obes Relat Dis 11(6):S6–S8
Kourosh S, Birch D, Sharma A, Karmali S (2013) Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide. Can J Surg 56(5):347–352
D’Hondt Mathieu, Vanneste Sofie, Pottel Hans et al (2011) Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss. Surg Endosc Surg Endosc 25(8):2498–2504
Tucker ON, Szomstein S, Rosenthal RJ (2008) Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gastrointest Surg 12(4):662–667
Goitein D, Feigin A, Segal-Lieberman G, Goitein O, Papa MZ, Zippel D (2011) Laparoscopic sleeve gastrectomy as a revisional option after gastric band failure. Surg Endosc 23(7):1559–1563
Foletto M, Prevedello L, Bernante P, Luca B, Vettor R, FranciniPesenti F, Scarda A, Brocadello F, Motter M, Famengo S, Nitti D (2012) Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty. Surg Obes Relat Dis 6:146–151
Frezza E, Reddy S, Gee LL, Wachtel MS (2009) Complications after sleeve gastrectomy for morbid obesity. Obes Surg 19:684–687
Gagner M (2010) Leaks after sleeve gastrectomy are associated with smaller bougies: prevention and treatment strategies. Surg Laparosc Endosc Percutan Tech 20:166–169
Lalor PF, Tucker ON, Szomstein S, Rosenthal R (2008) Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 4:33–38
Brethauer S, Hammel J, Schauer P (2009) Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis 5:469–475
Cottam D, Qureshi FG, Mattar SG, Sharma S, Holover S, Bonanomi G, Ramanathan R, Schauer P (2006) Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc 20:859–863
Parikh A, Alley JB, Peterson RM, Harnisch MC, Pfluke JM, Tapper DM, Fenton SJ (2011) Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese. Surg Endosc Surg Endosc 26(3):738–746
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Drs. Salman Al Sabah, Eliana Al Haddad and Iqbal Siddique have no conflicts of interest or financial ties to disclose.
Additional information
The original version of this article was revised: modification has been made in the author group, addition of third author Iqbal Siddique and second affiliation for Salman Al Sabah.
An erratum to this article is available at https://doi.org/10.1007/s00464-017-5592-z.
Rights and permissions
About this article
Cite this article
Al Sabah, S., Al Haddad, E. & Siddique, I. Endoscopic management of post-laparoscopic sleeve gastrectomy stenosis. Surg Endosc 31, 3559–3563 (2017). https://doi.org/10.1007/s00464-016-5385-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-016-5385-9