Roux-en-Y Gastric Bypass: Stomal Stenosis

Stomal stenosis is simply an anastomotic stricture at the gastrojejunal anastomosis of a Roux-en-Y gastric bypass (RYGB). It is one of the common postoperative complications of RYGB. The incidence is reported between 3.1% and 15.7%, depending on the type of anastomosis used. The method of anastomosis seems to have the greatest impact on the formation of stomal stenosis. It appears that the greatest risk of stenosis is conferred by use of a 21-mm circular stapler, followed in order by a 25-mm circular stapler, linear stapler, and handsewn anastomosis. There have been several studies showing no difference in weight loss between the different anastomotic methods. At least one major study shows no relationship between stomal stenosis and antecolic versus retrocolic anastomoses. There also is no gender, comorbidity, or BMI relationship to stomal stenosis. Stomal stenosis is significantly more common after revisional surgery.

The cause of stomal stenosis has not been scientifically proved; however, most believe that it is related to excessive scar formation or ischemia. Another possible cause is recurrent vomiting; however, since vomiting is one of the symptoms of stenosis, it is impossible to determine which came first. Finally, stomal stenosis can be associated with gastric/marginal ulcers, anasamotic banding, or with “pursestringing” of permanent suture material. In the case on concurrent ulcer disease stomal stenosis occurs late and may be caused by smoking or NSAID use.

Presenting symptoms include dysphagia, solid food intolerance, nausea, and vomiting. Presentation is usually 1 to 2 months postoperatively. Late presentation (>4 months) suggests concurrent pathology, such as ulcer, band material, or retained suture material.