Gastrojejunal Anastomotic Stricture Following Roux-en-Y Gastric Bypass: an Analysis of Anastomotic Technique at a Single Institution

Sundaresan, Naresh; Hiticas, B Amy; Sullivan, Mariel; Hui, Benedict; Poliakin, Lauren; Thompson, Kyle J.; McKillop, Iain H.; Barbat, Selwan; Kuwada, Timothy S.; Gersin, Keith S.; Nimeri, Abdelrahman

doi:10.1007/s11695-021-05678-2

Cited by 10 publications

(5 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…14,15 The development of strictures/stenoses and marginal ulcerations at the GJ anastomosis are well-recognized complication within the early postoperative period following LRYGB, with a reported an incidence of up to 28% and 18%, respectively. 36 These complications have also been reported post-LVSG, however, at considerably lower rates than with LRYGB (stenosis: up to 4% 36 ; ulcers: prevalence not available in the literature) 37,38 this has not been found in other studies. [39][40][41] In the RCTs included in the current work, a mix of circular-stapled and linear-stapled technique was described for the formation of the GJ anastomosis, but it remains unclear the significance of these changes with relation the outcomes reported.…”

Section: Discussionmentioning

confidence: 85%

Late (≥5 y) Complications of Laparoscopic Vertical Sleeve Gastrectomy (LVSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB): A Systematic Review and Meta-analysis of Randomized Controlled Trials

Osland

Alam

Khan

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

View full text Add to dashboard Cite

Background: There is a paucity of data that compares the relative complication profiles of laparoscopic vertical sleeve gastrectomy (LVSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) at 5 years. Objectives: The aim was to compare late complications of LVSG and LRYGB. Methods: We updated our previous systematic review and meta-analysis of randomized controlled trials of primary LVSG and LRYGB procedures in adults, to review late (5 years) complication outcomes (PROSPERO 112054). Electronic databases were searched from January 2015 to July 2021 for publications meeting inclusion criteria. The Hartung-Knapp-Sidik-Jonkman random effects model was utilized to estimate weighted mean differences where meta-analysis was possible. Bias and certainty of evidence was assessed using the Cochrane risk of bias tool and Grading of Recommendations, Assessment, Development and Evaluations. Results: Four randomized controlled trials met the inclusion criteria (n=531; LVSG=272, LRYGB=259). No late treatment-related mortality was reported with either procedure. A significant reduction in surgical reoperations (odds ratio: 0.47, 95% confidence interval: 0.27-0.82, P=0.01) and endoscopic interventions (odds ratio: 0.29, 95% confidence interval: 0.12-0.71, P=0.02) were reported at 5 years post-LVSG relative to LRYGB. Reoperations were more frequently performed for reflux management in LVSG and for internal hernia repairs in LRYGB. Complications requiring medical management were common following both procedures. Limitations included few eligible studies for inclusion, and varying definitions of medically managed complications. Conclusions: LRYGB is associated with a higher proportion of surgical and endoscopic interventions at 5 years compared with LVSG. More high-quality, long-term studies are required to further elucidate both surgical and nutritional long-term outcomes post these procedures.

show abstract

Section: Discussionmentioning

confidence: 85%

Late (≥5 y) Complications of Laparoscopic Vertical Sleeve Gastrectomy (LVSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB): A Systematic Review and Meta-analysis of Randomized Controlled Trials

Osland

Alam

Khan

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

View full text Add to dashboard Cite

show abstract

“…The Prisma flow chart for the study selection is shown in Figure 1. Twenty-one articles12–33 on bariatric surgery were included in one or more of the outcome analyses (7 prospective cohorts and 14 retrospective cohorts; Table 1). In total, 51,672 patients were included, of which 41,358 underwent surgery with LSA and 10,314 with CSA; The sample size of these studies ranged from 61 to 34.284 patients.…”

Section: Resultsmentioning

confidence: 99%

Linear Versus Circular Laparoscopic Gastrojejunal Anastomosis of Roux-en-Y Gastric Bypass: Systematic Review and Meta-Analysis of 22 Comparative Studies

Vitiello

Berardi

Velotti

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

View full text Add to dashboard Cite

Purpose: To compare the rate of complications of linear versus circular gastrojejunal anastomosis of laparoscopic Roux-en-Y gastric bypass. Methods: A systematic search of PubMed, Embase, and the Cochrane Library databases was carried out using the terms “laparoscopic,” “circular,” “linear,” “anastomosis,” “gastric bypass” in accordance to PRISMA guidelines. Only original articles in English language comparing linear versus circular anastomosis were included. No temporal interval was set. Outcome measures were wound infection, bleeding, marginal ulcer, leak, and stricture. Pooled odds ratio (OR) with a 95% confidence interval (CI) was calculated. Heterogeneity was assessed using the I 2 statistic. Funnel plots were used to detect publication bias. Results: Twenty-two articles (7 prospective and 15 retrospective) out of 184 retrieved papers were included in this study. The pooled analysis showed a reduced odd of wound infection and bleeding after linear anastomosis. Likelihood of marginal ulcer, leak, and stricture was similar after the 2 techniques. Wound infection was reported in 15 studies (OR, 0.17; 95% CI, 0.06-0.45; P=0.0003; I 2=91), bleeding in 9 (OR, 0.45; 95% CI, 0.34-0.59; P=0.00001; I 2=6) marginal ulcer in 11 (OR, 0.61; 95% CI, 0.26-1.41; P=0.25; I 2=65), leaks in 15 (OR, 0.61; 95% CI, 0.21-1.67; P=0.34; I 2=83) and stricture in 18 (OR, 0.48; 95% CI, 0.23-1.00; P=0.05; I 2=68). Conclusion: Laparoscopic RYGB can be safely performed both with circular and linear staplers. Rates of wound infection and bleeding were significantly lower after linear gastrojejunal anastomosis.

show abstract

“…Numerous studies to date have evaluated the effect of GJ size on weight loss outcomes after RYGB, with conflicting results 12–20. However, only a small number of studies have reported the impact of GJ stenosis on postoperative weight loss 7,9,13,15,21,22. Lee et al7 evaluated 426 patients who underwent RYGB with either hand-sewn, circular-stapled, or linear-stapled anastomoses, of whom 8% developed a GJ stricture.…”

Section: Discussionmentioning

confidence: 99%

Impact of Early Gastrojejunal Stenosis on Weight Loss in Patients Undergoing Roux-en-Y Gastric Bypass

Shariq¹,

Portela²,

Bews³

et al. 2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

View full text Add to dashboard Cite

Background: Gastrojejunal (GJ) anastomotic stenosis is a welldescribed complication after Roux-en-Y gastric bypass (RYGB); however, its impact on weight loss outcomes is not well elucidated. Methods:We performed a retrospective cohort study of adult patients who underwent RYGB at our institution between 2008 and 2020. Propensity score matching was used to match 30 patients who developed GJ stenosis within the first 30 days post-RYGB with 120 control patients who did not develop this outcome. Short and longterm complications and mean percentage of total body weight loss (TWL) were recorded at 3 months, 6 months, 1 year, 2 years, 3 to 5 years, and 5 to 10 years postoperatively. Hierarchical linear regression modeling was used to analyze the association between early GJ stenosis and the mean percentage of TWL.Results: Patients who developed early GJ stenosis had a 13.6% increase in the mean percentage of TWL when compared with controls in the hierarchical linear model [P < 0.001 (95% CI: 5.7; 21.5)]. These patients were also more likely to present to an intravenous infusion center (70% vs 4%; P < 0.01), require readmission within 30 days (16.7% vs 2.5%; P < 0.01), and/or develop an internal hernia (23.3% vs 5.0%) postoperatively.Conclusions: Patients who develop early GJ stenosis after RYGB have a greater degree of long-term weight loss compared with patients who do not develop this complication. Although our findings support the key contribution that restrictive mechanisms play in maintaining weight loss after RYGB, GJ stenosis remains a complication associated with significant morbidity.

show abstract

Gastrojejunal Anastomotic Stricture Following Roux-en-Y Gastric Bypass: an Analysis of Anastomotic Technique at a Single Institution

Cited by 10 publications

References 17 publications

Late (≥5 y) Complications of Laparoscopic Vertical Sleeve Gastrectomy (LVSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB): A Systematic Review and Meta-analysis of Randomized Controlled Trials

Late (≥5 y) Complications of Laparoscopic Vertical Sleeve Gastrectomy (LVSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB): A Systematic Review and Meta-analysis of Randomized Controlled Trials

Linear Versus Circular Laparoscopic Gastrojejunal Anastomosis of Roux-en-Y Gastric Bypass: Systematic Review and Meta-Analysis of 22 Comparative Studies

Impact of Early Gastrojejunal Stenosis on Weight Loss in Patients Undergoing Roux-en-Y Gastric Bypass

Contact Info

Product

Resources

About