Skip to main content

Advertisement

Log in

Laparoscopic Management of Persistent Strictures After Laparoscopic Sleeve Gastrectomy

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) has become a common option in the management of morbid obesity. Although this procedure seems easier, many caveats remain, especially in terms of leakage. Other serious complications include strictures, bleeding, and gastroesophageal reflux disease (GERD). Strictures are related to operative technique but also to healed leaks and fistulas. To our knowledge, the literature reports on the physiopathology and management of strictures after LSG are scarce.

Methods

A retrospective analysis of our database provided a total of 16 patients who underwent laparoscopic surgery for the treatment of strictures. A comprehensive review of each case was done including their management.

Results

Sixteen patients were treated laparoscopically for strictures. There were eight females (mean age, 40.6 years). Most common complaints were dysphagia (n = 14) and/or GERD (n = 8). Body Mass Index was 30.5 kg/m2 ± 9.3. Fourteen patients underwent a seromyotomy (SM) and two a wedge resection of the stenosis. After SM, morbidity included five leaks on the short term and five reoperations in the long-term. Of the 16 patients, 12 were treated satisfactorily, three required endoscopies and one had minimal GERD symptoms.

Conclusions

Strictures and stenosis can be managed by laparoscopic approach with acceptable results. SM can be useful but carries a high complication rate. Accurate technique with parsimonious use of coagulation and possibly with the systematic use of an omental patch might lead to better results. The wedge resection of the stomach including the stricture was performed successfully in two cases. In addition, wedge resection was used secondarily in two other cases to address a complication of the seromyotomy.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg. 2008;18:487–96.

    Article  PubMed  Google Scholar 

  2. Brethauer SA, Hammel J, Schauer PR. Systematic review of sleeve gastrectomy as a staging and primary bariatric operation. Surg Obes Relat Dis. 2009;5:469–75.

    Article  PubMed  Google Scholar 

  3. Tucker ON, Szomstein S, Rosenthal RJ. Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gastrointest Surg. 2008;12:662–7.

    Article  PubMed  CAS  Google Scholar 

  4. Baltasar A, Serra C, Perez N, et al. Laparoscopic sleeve gastrectomy: a multipurpose bariatric operation. Obes Surg. 2005;15:1124–8.

    Article  PubMed  Google Scholar 

  5. Rosenthal RA. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of 12,000 cases. Surg Obes Relat Dis. 2012;8:8–19.

    Article  PubMed  Google Scholar 

  6. Dapri G, Cadière GB, Himpens J. Laparoscopic seromyotomy for long stenosis after sleeve gastrectomy with or without duodenal switch. Obes Surg. 2009;19:495–9.

    Article  PubMed  Google Scholar 

  7. Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252:319–24.

    Article  PubMed  Google Scholar 

  8. Gagner M, Deitel M, Kalberer TL, Erickson AL, Crosby RD. The second international consensus summit for sleeve gastrectomy, March 19-21, 2009. Surg Obes Relat Dis. 2009;5:476–85.

    Article  PubMed  Google Scholar 

  9. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26:1509–15.

    Article  PubMed  Google Scholar 

  10. Lalor PF, Tucker ON, Szomstein S, et al. Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2008;4:33–8.

    Article  PubMed  Google Scholar 

  11. Zundel N, Hernandez JD, Galvao Neto M, Campos J. Strictures after laparoscopic sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech. 2010;20:154–8.

    Article  PubMed  Google Scholar 

  12. Parikh A, Alley JB, Peterson RM, Harnisch MC, Pfluke JM, Tapper DM, et al. Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese. Surg Endosc. 2012;26:738–46.

    Article  PubMed  Google Scholar 

  13. Cerfolio RJ, Bryant AS, Canon CL, Dhawan R, Eloubeidi MA. Is botulinum toxin injection of the pylorus during Ivor Lewis [corrected] esophagogastrectomy the optimal drainage strategy? J Thorac Cardiovasc Surg. 2009;137(3):565–72.

    Article  PubMed  Google Scholar 

  14. Greenbaum DF, Wasser SH, Riley T, Juengert T, Hubler J, Angel K. Duodenal switch with omentopexy and feeding jejunostomy—a safe and effective revisional operation for failed previous weight loss surgery. Surg Obes Relat Dis. 2011;7:213–8.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interests Disclosure Statement

Dr. Ramon Vilallonga and Dr. Simon Van de Vrande Simon have no conflicts of interest. Dr. Jacques Himpens is a consultant for Ethicon Endosurgery and Gore.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ramon Vilallonga.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vilallonga, R., Himpens, J. & van de Vrande, S. Laparoscopic Management of Persistent Strictures After Laparoscopic Sleeve Gastrectomy. OBES SURG 23, 1655–1661 (2013). https://doi.org/10.1007/s11695-013-0993-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-013-0993-0

Keywords

Navigation