Gastrojejunal Anastomotic Stenosis in Laparoscopic Gastric Bypass with a Circular Stapler (21 mm): Incidence, Treatment and Long-term Follow-up

One of the keys to the long-term success of laparoscopic gastric bypass (LGBP) is performing a small-diameter gastrojejunal anastomosis, which occasionally involves an increased incidence of stenosis. Between May 2000 and October 2008, 676 patients underwent LGBP with a no. 21 circular stapler to create the gastrojejunoanastomosis (GJA). We define stenosis when clinical symptoms suggest an obstruction and it is impossible to pass a 10-mm endoscope through the GJA. The treatment of patients with stenosis was endoscopic dilation with 10-15-mm balloons. A total of 23 patients (3.4%) developed stenosis of whom 20 were females (3%) and three males (0.4%) with a mean age of 40.7 +/- 11.6 years (range, 16-71 years) and a body mass index of 48.1 +/- 6.9 kg/m(2) (range, 34-78 kg/m(2)). The time between surgery and the onset of symptoms was 46.8 +/- 24.5 days (range, 15-93 days). The stricture was resolved in all patients with endoscopic dilation: 18 patients with one dilation, three patients with two dilations and two patients with three dilations. There were no complications. The incidence of gastrojejunal anastomotic stenosis in LGBP performed with a 21-mm circular stapler is low, and endoscopic dilation is an effective and complication-free treatment in 100% of cases.