Skip to main content
SpringerLink
Log in

Predicting Stricture in Morbidly Obese Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass: A Logistic Regression Analysis

  • Published:
Journal of Gastrointestinal Surgery

Abstract

Gastrojejunostomy stricture after Roux-en-Y gastric bypass occurs in 3 to 27% of morbidly obese patients in the USA. We questioned whether preoperative patient characteristics, including demographic attributes and comorbid disease, might be significant factors in the etiology of stricture. In this study from November 2001 to February 2006 (51 months), at a high-volume bariatric center, of the 1,351 patients who underwent laparoscopic gastric bypass, 92 developed stricture (6.8%). All but two were treated successfully by endoscopic dilation. All patients stopped nonsteroidal anti-inflammatory medications 2 weeks prior to surgery and did not restart them. The operative procedure included the use of a 21-mm transoral circular stapler to create the gastrojejunostomy; the Roux limb was brought retrogastric, retrocolic. In an effort to reduce our center’s stricture rate, late in the study, U-clips used at the gastrojejunostomy were replaced by absorbable sutures, and postoperative H2 antagonists were added to the treatment protocol. The change to absorbable polyglactin suture proved to be significant, resulting in a lower stricture rate. The addition of H2 antagonists showed no significant effect. Following the retrospective review of the prospective database, univariate and multivariate logistic regression analyses identified factors associated with the development of stricture. Gastroesophageal reflux disease and age were each shown to be statistically significant independent predictors of stricture following laparoscopic gastric bypass.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Flancbaum L, Choban PS. Surgical implications of obesity. Annu Rev Med 1998;49:215–234.

    Article  PubMed  CAS  Google Scholar 

  2. MacLean LD, Rhode BM, Sampalis J, Forse RA. Results of the surgical treatment of obesity. Am J Surg 1993;165:155–159.

    Article  PubMed  CAS  Google Scholar 

  3. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and metaanalysis. JAMA 2004;292:1724–1737.

    Article  PubMed  CAS  Google Scholar 

  4. Yale CE. Gastric surgery for morbid obesity: complications and long-term weight control. Arch Surg 1989;124:941–946.

    PubMed  CAS  Google Scholar 

  5. Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean AP, MacLean LD. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 2004;240(3):416–423; discussion 423–424.

    Article  PubMed  Google Scholar 

  6. Choban PS, Onyejekwe J, Burge JC, Flancbaum L. A health status assessment of the impact of weight loss following Roux-en-Y gastric bypass for clinically severe obesity. J Am Coll Surg 1999;188(5):491–497.

    Article  PubMed  CAS  Google Scholar 

  7. Wittgrove AC, Clark GW, Tremblay CJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg 1994;4:353–357.

    Article  PubMed  Google Scholar 

  8. Nguyen NT, Lee SL, Goldman C, Fleming N, Arango A, McFall R, Wolfe B. Comparison of pulmonary function and postoperative pain after laparoscopic versus open gastric bypass: a randomized trial. J Am Coll Surg 2001;192(4):469–476; discussion 476–477.

    Article  PubMed  CAS  Google Scholar 

  9. Higa KD, Boone KB, Ho T, Davies OG. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. Arch Surg 2000;135:1029–1034.

    Article  PubMed  CAS  Google Scholar 

  10. Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y- 500 patients: technique and results, with 3–60 month follow-up. Obes Surg 2000;10(3):233–239.

    Article  PubMed  CAS  Google Scholar 

  11. El Shobary H, Christou N, Backman SB, Gvocdic B, Schricker T. Effect of laparoscopic versus open gastric bypass surgery on postoperative pain and bowel function. Obes Surg 2006;16(4):437–442.

    Article  PubMed  Google Scholar 

  12. Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000;232(4):515–529.

    Article  PubMed  CAS  Google Scholar 

  13. Westling A, Gustavsson S. Laparoscopic vs open Roux-en-Y gastric bypass: a prospective, randomized trial. Obes Surg 2001;11:284–292.

    Article  PubMed  CAS  Google Scholar 

  14. Nguyen NT, Silver M, Robinson M, Needleman B, Hartley G, Cooney R, Catalano R, Dostal J, Sama D, Blankenship J, Burg K, Stemmer E, Wilson SE. Result of a national audit of bariatric surgery performed at academic centers: a 2004 University HealthSystem Consortium Benchmarking Project. Arch Surg 2006;141(5):445–449; discussion 449–450.

    Article  PubMed  Google Scholar 

  15. Puzziferri N, Austrheim-Smith IT, Wolfe BM, Wilson SE, Nguyen NT. Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg 2006;243(2):181–188.

    Article  PubMed  Google Scholar 

  16. Matthews BD, Sing RF, DeLegge MH, et al. Initial results with a stapled gastrojejunostomy for the laparoscopic isolated Roux-en-Y gastric bypass. Am J Surg 2000;179:476–481.

    Article  PubMed  CAS  Google Scholar 

  17. Schauer P, Ikramuddin S, Hamad G, Gourash W. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc 2003;17(2):212–215.

    Article  PubMed  CAS  Google Scholar 

  18. Sanyal AJ, Sugerman HJ, Kellum JM, et al. Stomal complications of gastric bypass: incidence and outcome of therapy. Am J Gastroenterol 1992;87:1165–1169.

    PubMed  CAS  Google Scholar 

  19. Schirmer BD. Strictures and marginal ulcers in bariatric surgery. In: Buchwald H, Pories WJ, Cowan GSM, eds. Surgical Management of Morbid Obesity. New York: Elsevier, 2006, in press.

  20. Perugini RA, Mason R, Czerniach DR, Novitsky YW, Baker S, Litwin DE, Kelly JJ. Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients. Arch Surg 2003;138(5):541–545; discussion 545–546.

    Article  PubMed  Google Scholar 

  21. Goitein D, Papasavas PK, Gagne D, Ahmad S, Caushaj PF. Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc 2005;19(5):628–632.

    Article  PubMed  CAS  Google Scholar 

  22. Rossi TR, Dynda DI, Estes NC, Marshall JS. Stricture dilation after laparoscopic Roux-en-Y gastric bypass. Am J Surg 2005;189(3):357–360.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We want to thank our Gastroenterology colleagues, Jay Mellen, MD, and Leon Rigberg, MD, who have worked with our team in the treatment of our gastric bypass patients with a collaborative demeanor and flawless technique. We must also thank the nursing staff at Scottsdale Healthcare and the office staff of Scottsdale Bariatric Center for their kind and considerate care of patients who are struggling with life after surgery. We acknowledge J. N. Buchwald, M.A., for her consultation and editing of the manuscript. Finally, our thanks go to all our family and friends who endure us during our efforts to communicate our research.

Author information

Authors and Affiliations

  1. Scottsdale Bariatric Center at Scottsdale Healthcare, 10200 N. 92nd Street, Suite 225, Scottsdale, AZ, 85258, USA

    Robin P. Blackstone & Lisa A. Rivera

Authors
  1. Robin P. Blackstone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lisa A. Rivera
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robin P. Blackstone.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Blackstone, R.P., Rivera, L.A. Predicting Stricture in Morbidly Obese Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass: A Logistic Regression Analysis. J Gastrointest Surg 11, 403–409 (2007). https://doi.org/10.1007/s11605-007-0135-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-007-0135-x

Keywords

Search

Navigation