Laparoscopic Management of Persistent Strictures After Laparoscopic Sleeve Gastrectomy

Abstract

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.

Complications in bariatric surgery

“…The incidence of strictures after sleeve gastrectomy is around 3.5%. [35] It is mostly induced by scar retraction. The incisura angularis is the place with the greatest potential place for stricture development.…”

“…These treatment options are seromyotomy, sleeve wedge resection, and conversion to gastric bypass. [35] …”

Refractory complex gastrobroncho-cutaneous fistula after laparoscopic sleeve gastrectomy: a novel technique for endoscopic management

“…Endoscopic procedures include application of self-expanding metallic stents, balloon dilation of distal stricture, and stricturotomy [8]. Reoperation for treatment of gastric fistula after LSG is indicated for chronic and refractory fistulae and is associated with higher morbidity and mortality [10]. Surgical procedures include surgical drainage, total gastrectomy, Roux-en-Y esophagojejunostomy, Roux-en-Y gastrojejunostomy, and fistulojejunostomy [6,11].…”

Bariatric postoperative fistula: a life-saving endoscopic procedure

“…Difficulties in treating this complication have led to major thoracic and abdominal surgery, such as total gastrectomy, which can increase morbidity and mortality [4,5]. Therapeutic endoscopy is a minimally invasive procedure that could be implemented to treat gastric fistula considering the increased risk of complications secondary to a surgical approach [5][6][7][8].…”

“…Therapeutic endoscopy is a minimally invasive procedure that could be implemented to treat gastric fistula considering the increased risk of complications secondary to a surgical approach [5][6][7][8]. However, conventional endoscopic treatment of bariatric postoperative fistula is challenging due to persistent abscess and/or distal stenosis.…”