Management of Strictures

  • Ninh T. Nguyen
  • Xuan-Mai T. Nguyen


Anastomotic stenosis is one of the most common delayed complications following Roux-en-Y gastric bypass. Stricture at the gastrojejunal anastomosis can lead to symptoms of progressive dysphagia, nausea, and emesis. Stricture diagnosis is typically made via endoscopy, and definitive treatment can usually be achieved with endoscopic methods of stricture dilation. This chapter reviews diagnosis and management of strictures in the bariatric patient.


Gastric Bypass Balloon Catheter Anastomotic Stricture Roux Limb Circular Stapler 
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  1. 1.
    Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y 500 patients: technique and results, with 3–60 month follow-up. Obes Surg. 2000;10:233–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Gonzalez R, Lin E, Venkatesh KR, Bowers SP, Smith CD. Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques. Arch Surg. 2003;138:181–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Higa KD, Ho T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Tech. 2001;11:377–82.CrossRefGoogle Scholar
  4. 4.
    Abdel-Galil E, Sabry AA. Laparoscopic Roux-en-Y gastric bypass—evaluation of three different techniques. Obes Surg. 2002;12:639–42.PubMedCrossRefGoogle Scholar
  5. 5.
    Madan AK, Harper JL, Tichansky DS. Techniques of laparoscopic gastric bypass: on-line survey of American Society for Bariatric Surgery practicing surgeons. Surg Obes Relat Dis. 2008;4(2):166–72.PubMedCrossRefGoogle Scholar
  6. 6.
    Nguyen NT, Stevens CM, Wolfe BM. Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass. J Gastrointest Surg. 2003;7(8):997–1003.PubMedCrossRefGoogle Scholar
  7. 7.
    Suggs WJ, Kouli W, Lupovici M, et al. Complications at gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass: comparison between 21- and 25-mm circular staplers. Surg Obes Relat Dis. 2007;3(5):508–14.PubMedCrossRefGoogle Scholar
  8. 8.
    Stahl RD, Sherer RA, Seevers CE, Johnston D. Comparison of 21 vs. 25 mm gastrojejunostomy in the gastric bypass procedure—early results. Obes Surg. 2000;10:540–2.PubMedCrossRefGoogle Scholar
  9. 9.
    Cottam DR, Fisher B, Sridhar V, et al. The effect of stoma size on weight loss after laparoscopic gastric bypass surgery: results of a blinded randomized controlled trial. Obes Surg. 2009;19(1):13–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Mathew A, Veliuona MA, DePalma FJ, Cooney RN. Gastrojejunal stricture after gastric bypass and efficacy of endoscopic intervention. Dig Dis Sci. 2009;54(9):1971–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Barba CA, Butensky MS, Lorenzo M, Newman R. Endoscopic dilation of gastroesophageal anastomosis stricture after gastric bypass. Surg Endosc. 2003;17:416–20.PubMedCrossRefGoogle Scholar
  12. 12.
    Go MR, Muscarella P, Needleman BJ, et al. Endoscopic management of stomal stenosis after Roux-en-Y gastric bypass. Obes Surg. 2004;18(1):56–9.Google Scholar
  13. 13.
    Peifer KJ, Shiels AJ, Azar R, et al. Successful endoscopic management of gastrojejunal anastomotic strictures after Roux-en-Y gastric bypass. Gastrointest Endosc. 2007;66(2):248–52.PubMedCrossRefGoogle Scholar
  14. 14.
    Escalona A, Devaud N, Boza C, et al. Gastrojejunal anastomotic stricture after Roux-en-Y gastric bypass: ambulatory management with the Savary-Gilliard dilator. Surg Endosc. 2007;21(5):765–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Fernandez-Esparrach G, Bordas JM, Llach J, et al. Endoscopic dilation with Savary-Gilliard bougies of stomal strictures after laparoscopic gastric bypass in morbidly obese patients. Obes Surg. 2008;18(2):155–61.PubMedCrossRefGoogle Scholar
  16. 16.
    Ukleja A, Afonso BB, Pimentel R, et al. Outcome of endoscopic balloon dilation of strictures after laparoscopic gastric bypass. Surg Endosc. 2008;22(8):1746–50.PubMedCrossRefGoogle Scholar
  17. 17.
    Alasfar F, Sabniss AA, Liu RC, Chand B. Stricture rate after laparoscopic Roux-en-Y gastric bypass with a 21-mm circular stapler: the Cleveland Clinic experience. Med Princ Pract. 2009;18(5):364–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Caro L, Sanchez C, Rodriguez P, Bosch J. Endoscopic balloon dilation of anastomotic strictures occurring after laparoscopic gastric bypass for morbid obesity. Dig Dis. 2008;26(4):314–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Surgery, Irvine Medical CenterUniversity of CaliforniaOrangeUSA

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