Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese

Amit Parikh, Joshua B. Alley, Richard M Peterson, Michael C. Harnisch, Jason M. Pfluke, Donovan M. Tapper, Stephen J. Fenton

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Background: This study aimed to determine the incidence, etiology, and management options for symptomatic stenosis (SS) after laparoscopic sleeve gastrectomy (LSG). Methods: A retrospective study reviewed morbidly obese patients who underwent LSG between October 2008 and December 2010 to identify patients treated for SS. Results: In this study, 230 patients (83% female) with a mean age of 49.5 years and a mean body mass index (BMI) of 43 kg/m 2 underwent LSG. In 3.5% of these patients (100% female; mean age, 42 years; mean BMI, 42.6 kg/m 2), SS developed. The LSG procedure was performed using a 36-Fr. bougie and tissue-reinforced staplers. Four patients had segmental staple-line imbrication, and seven patients underwent contrast study, with 71.4% demonstrating a fixed narrowing. Endoscopy confirmed short-segment stenoses: seven located at mid-body and one located near the gastroesophageal junction. Endoscopic management was 100% successful. The mean number of dilations was 1.6, and the median balloon size was 15 mm. The mean time from surgery to initial endoscopic intervention was 48.8 days, and the mean time from the first dilation to toleration of a solid diet was 49.6 days. Two patients were referred to our institution after undergoing LSG at another facility. The mean time to the transfer was 28.5 days. The two patients had a mean age of 35 years and a mean BMI of 42.3 kg/m 2. Both patients experienced immediate SS after perioperative complications comprising one staple-line hematoma and one leak. Contrast studies demonstrated minimal passage of contrast through a long-segment stenosis. Both patients underwent multiple endoscopic dilation procedures and endoluminal stenting, ultimately requiring laparoscopic conversion to Roux-en-Y gastric bypass. The mean time from the initial surgery to the surgical revision was 77 days, and the mean time after the first intervention to tolerance of a solid diet was 82 days. Conclusion: Symptomatic short-segment stenoses after LSG may be treated successfully with endoscopic balloon dilation. Long-segment stenoses that do not respond to endoscopic techniques may ultimately require conversion to Roux-en-Y gastric bypass.

Original languageEnglish (US)
Pages (from-to)738-746
Number of pages9
JournalSurgical Endoscopy and Other Interventional Techniques
Volume26
Issue number3
DOIs
StatePublished - Mar 2012

Fingerprint

Gastrectomy
Pathologic Constriction
Dilatation
Body Mass Index
Gastric Bypass
Diet
Esophagogastric Junction
Reoperation
Hematoma
Endoscopy
Retrospective Studies
Incidence

Keywords

  • Bariatric
  • Complications
  • Obesity

ASJC Scopus subject areas

  • Surgery

Cite this

Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese. / Parikh, Amit; Alley, Joshua B.; Peterson, Richard M; Harnisch, Michael C.; Pfluke, Jason M.; Tapper, Donovan M.; Fenton, Stephen J.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 26, No. 3, 03.2012, p. 738-746.

Research output: Contribution to journalArticle

Parikh, Amit ; Alley, Joshua B. ; Peterson, Richard M ; Harnisch, Michael C. ; Pfluke, Jason M. ; Tapper, Donovan M. ; Fenton, Stephen J. / Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese. In: Surgical Endoscopy and Other Interventional Techniques. 2012 ; Vol. 26, No. 3. pp. 738-746.
@article{cac73b47cc90447fb8f6f80466fcace8,
title = "Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese",
abstract = "Background: This study aimed to determine the incidence, etiology, and management options for symptomatic stenosis (SS) after laparoscopic sleeve gastrectomy (LSG). Methods: A retrospective study reviewed morbidly obese patients who underwent LSG between October 2008 and December 2010 to identify patients treated for SS. Results: In this study, 230 patients (83{\%} female) with a mean age of 49.5 years and a mean body mass index (BMI) of 43 kg/m 2 underwent LSG. In 3.5{\%} of these patients (100{\%} female; mean age, 42 years; mean BMI, 42.6 kg/m 2), SS developed. The LSG procedure was performed using a 36-Fr. bougie and tissue-reinforced staplers. Four patients had segmental staple-line imbrication, and seven patients underwent contrast study, with 71.4{\%} demonstrating a fixed narrowing. Endoscopy confirmed short-segment stenoses: seven located at mid-body and one located near the gastroesophageal junction. Endoscopic management was 100{\%} successful. The mean number of dilations was 1.6, and the median balloon size was 15 mm. The mean time from surgery to initial endoscopic intervention was 48.8 days, and the mean time from the first dilation to toleration of a solid diet was 49.6 days. Two patients were referred to our institution after undergoing LSG at another facility. The mean time to the transfer was 28.5 days. The two patients had a mean age of 35 years and a mean BMI of 42.3 kg/m 2. Both patients experienced immediate SS after perioperative complications comprising one staple-line hematoma and one leak. Contrast studies demonstrated minimal passage of contrast through a long-segment stenosis. Both patients underwent multiple endoscopic dilation procedures and endoluminal stenting, ultimately requiring laparoscopic conversion to Roux-en-Y gastric bypass. The mean time from the initial surgery to the surgical revision was 77 days, and the mean time after the first intervention to tolerance of a solid diet was 82 days. Conclusion: Symptomatic short-segment stenoses after LSG may be treated successfully with endoscopic balloon dilation. Long-segment stenoses that do not respond to endoscopic techniques may ultimately require conversion to Roux-en-Y gastric bypass.",
keywords = "Bariatric, Complications, Obesity",
author = "Amit Parikh and Alley, {Joshua B.} and Peterson, {Richard M} and Harnisch, {Michael C.} and Pfluke, {Jason M.} and Tapper, {Donovan M.} and Fenton, {Stephen J.}",
year = "2012",
month = "3",
doi = "10.1007/s00464-011-1945-1",
language = "English (US)",
volume = "26",
pages = "738--746",
journal = "Surgical Endoscopy and Other Interventional Techniques",
issn = "0930-2794",
publisher = "Springer New York",
number = "3",

}

TY - JOUR

T1 - Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese

AU - Parikh, Amit

AU - Alley, Joshua B.

AU - Peterson, Richard M

AU - Harnisch, Michael C.

AU - Pfluke, Jason M.

AU - Tapper, Donovan M.

AU - Fenton, Stephen J.

PY - 2012/3

Y1 - 2012/3

N2 - Background: This study aimed to determine the incidence, etiology, and management options for symptomatic stenosis (SS) after laparoscopic sleeve gastrectomy (LSG). Methods: A retrospective study reviewed morbidly obese patients who underwent LSG between October 2008 and December 2010 to identify patients treated for SS. Results: In this study, 230 patients (83% female) with a mean age of 49.5 years and a mean body mass index (BMI) of 43 kg/m 2 underwent LSG. In 3.5% of these patients (100% female; mean age, 42 years; mean BMI, 42.6 kg/m 2), SS developed. The LSG procedure was performed using a 36-Fr. bougie and tissue-reinforced staplers. Four patients had segmental staple-line imbrication, and seven patients underwent contrast study, with 71.4% demonstrating a fixed narrowing. Endoscopy confirmed short-segment stenoses: seven located at mid-body and one located near the gastroesophageal junction. Endoscopic management was 100% successful. The mean number of dilations was 1.6, and the median balloon size was 15 mm. The mean time from surgery to initial endoscopic intervention was 48.8 days, and the mean time from the first dilation to toleration of a solid diet was 49.6 days. Two patients were referred to our institution after undergoing LSG at another facility. The mean time to the transfer was 28.5 days. The two patients had a mean age of 35 years and a mean BMI of 42.3 kg/m 2. Both patients experienced immediate SS after perioperative complications comprising one staple-line hematoma and one leak. Contrast studies demonstrated minimal passage of contrast through a long-segment stenosis. Both patients underwent multiple endoscopic dilation procedures and endoluminal stenting, ultimately requiring laparoscopic conversion to Roux-en-Y gastric bypass. The mean time from the initial surgery to the surgical revision was 77 days, and the mean time after the first intervention to tolerance of a solid diet was 82 days. Conclusion: Symptomatic short-segment stenoses after LSG may be treated successfully with endoscopic balloon dilation. Long-segment stenoses that do not respond to endoscopic techniques may ultimately require conversion to Roux-en-Y gastric bypass.

AB - Background: This study aimed to determine the incidence, etiology, and management options for symptomatic stenosis (SS) after laparoscopic sleeve gastrectomy (LSG). Methods: A retrospective study reviewed morbidly obese patients who underwent LSG between October 2008 and December 2010 to identify patients treated for SS. Results: In this study, 230 patients (83% female) with a mean age of 49.5 years and a mean body mass index (BMI) of 43 kg/m 2 underwent LSG. In 3.5% of these patients (100% female; mean age, 42 years; mean BMI, 42.6 kg/m 2), SS developed. The LSG procedure was performed using a 36-Fr. bougie and tissue-reinforced staplers. Four patients had segmental staple-line imbrication, and seven patients underwent contrast study, with 71.4% demonstrating a fixed narrowing. Endoscopy confirmed short-segment stenoses: seven located at mid-body and one located near the gastroesophageal junction. Endoscopic management was 100% successful. The mean number of dilations was 1.6, and the median balloon size was 15 mm. The mean time from surgery to initial endoscopic intervention was 48.8 days, and the mean time from the first dilation to toleration of a solid diet was 49.6 days. Two patients were referred to our institution after undergoing LSG at another facility. The mean time to the transfer was 28.5 days. The two patients had a mean age of 35 years and a mean BMI of 42.3 kg/m 2. Both patients experienced immediate SS after perioperative complications comprising one staple-line hematoma and one leak. Contrast studies demonstrated minimal passage of contrast through a long-segment stenosis. Both patients underwent multiple endoscopic dilation procedures and endoluminal stenting, ultimately requiring laparoscopic conversion to Roux-en-Y gastric bypass. The mean time from the initial surgery to the surgical revision was 77 days, and the mean time after the first intervention to tolerance of a solid diet was 82 days. Conclusion: Symptomatic short-segment stenoses after LSG may be treated successfully with endoscopic balloon dilation. Long-segment stenoses that do not respond to endoscopic techniques may ultimately require conversion to Roux-en-Y gastric bypass.

KW - Bariatric

KW - Complications

KW - Obesity

UR - http://www.scopus.com/inward/record.url?scp=84857038906&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84857038906&partnerID=8YFLogxK

U2 - 10.1007/s00464-011-1945-1

DO - 10.1007/s00464-011-1945-1

M3 - Article

VL - 26

SP - 738

EP - 746

JO - Surgical Endoscopy and Other Interventional Techniques

JF - Surgical Endoscopy and Other Interventional Techniques

SN - 0930-2794

IS - 3

ER -