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Khrucharoen U, Weitzner ZN, Chen Y, Dutson EP. Incidence and risk factors for early gastrojejunostomy anastomotic stricture requiring endoscopic intervention following laparoscopic Roux-en-Y gastric bypass: a MBSAQIP analysis. Surg Endosc 2022; 36:3833-3842. [PMID: 34471978 DOI: 10.1007/s00464-021-08700-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/23/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Gastrojejunostomy (GJ) stricture is one of the most commonly recognized complications following laparoscopic Roux-en-Y gastric bypass (LRYGB). The risks involving the formation of early GJ stomal stenosis are largely unknown. The aims of this study are to evaluate the rate and risk factors associated with GJ stricture in patients requiring esophagogastroduodenoscopy (EGD) within 30 days after LRYGB. METHODS This is a retrospective study of patients who underwent EGD for GJ stricture following LRYGB. Data were retrieved from MBSAQIP database from 2015 to 2018. Descriptive, bivariate, and logistic regression analyses were performed. Those who had reoperation, readmission, and intervention for other indications rather than GJ stricture were excluded from the risk factor analysis. RESULTS 760,076 patients underwent bariatric surgery. Of these, 184,660 (24.3%) underwent LRYGB and 875 had GJ stricture within 30 days postoperatively. The overall incidence of early GJ stricture after LRYGB was 4.7 per 1000 person-years. The incidence decreased from 6.2 to 3.4 per 1000 person-years during the 4-year period. 85% of patients with GJ stricture required therapeutic intervention. Median (IQR) day to the first endoscopic intervention was 25 (21-28) days. The overall 30-day readmission rate was 40%. 30-day reoperation rate due to GJ stricture was 5.6%. No 30-day mortality occurred. Factors independently associated with an increased risk for early GJ stricture include concurrent hiatal hernia repair (Adjusted Odds Ratio-AOR 1.8, 95% CI 1.5-2.2), revision case (AOR 1.4, 95% CI 1.1-1.6), African American (AOR 1.4, 95% CI 1.2-1.7), gastroesophageal reflux disease-GERD (AOR 1.4, 95% CI 1.2-1.5), drain placement (AOR 1.3, 95% CI1.1-1.4), and routine postoperative swallow study (AOR 1.3, 95% CI 1.1-1.50). CONCLUSION The incidence of early GJ stricture following LRYGB decreased at MBSAQIP-accredited centers over the review period. Patients having additional manipulation at or around GJ were at risk of developing early GJ stricture after LRYGB.
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Affiliation(s)
- Usah Khrucharoen
- Department of Surgery, Section of Minimally Invasive and Bariatric Surgery, David Geffen School of Medicine at University of California, Box 956904, 72-239 CHS, Los Angeles, CA, 90095, USA.,UCLA Center for Obesity and METabolic Health (COMET), Los Angeles, CA, USA.,UCLA Center for Advanced Surgical & Interventional Technology (CASIT), Los Angeles, CA, USA
| | - Zachary N Weitzner
- Department of Surgery, Section of Minimally Invasive and Bariatric Surgery, David Geffen School of Medicine at University of California, Box 956904, 72-239 CHS, Los Angeles, CA, 90095, USA.,UCLA Center for Obesity and METabolic Health (COMET), Los Angeles, CA, USA.,UCLA Center for Advanced Surgical & Interventional Technology (CASIT), Los Angeles, CA, USA
| | - Yijun Chen
- Department of Surgery, Section of Minimally Invasive and Bariatric Surgery, David Geffen School of Medicine at University of California, Box 956904, 72-239 CHS, Los Angeles, CA, 90095, USA.,UCLA Center for Obesity and METabolic Health (COMET), Los Angeles, CA, USA
| | - Erik P Dutson
- Department of Surgery, Section of Minimally Invasive and Bariatric Surgery, David Geffen School of Medicine at University of California, Box 956904, 72-239 CHS, Los Angeles, CA, 90095, USA. .,UCLA Center for Obesity and METabolic Health (COMET), Los Angeles, CA, USA. .,UCLA Center for Advanced Surgical & Interventional Technology (CASIT), Los Angeles, CA, USA.
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Swallow Magnetic Resonance Imaging Compared to 3D-Computed Tomography for Pouch Assessment and Hiatal Hernias After Roux-en-Y Gastric Bypass. Obes Surg 2020; 30:4192-4197. [PMID: 32564309 PMCID: PMC7525276 DOI: 10.1007/s11695-020-04758-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction/Purpose Weight regain and weight loss failure after bariatric surgery are important issues that may require a weight regain procedure. Three-dimensional-computed tomography (3D-CT) is a well-established method allowing exact measurements of pouch volume. The aims of this study were to prove the applicability of swallow MRI as a non-ionizing procedure and compare it to 3D-CT in patients after weight regain procedures following RYGB. Materials and Methods Twelve post-RYGB patients who had a follow-up operation for weight regain before 12/2017 were included in this prospective study. Swallow MRI and 3D-CT were performed in each patient to evaluate the size of the anastomosis, pouch volume, and intrathoracic pouch migration (ITM). Results Mean pouch volume in swallow MRI and 3D-CT were 40.4 ± 21.0 ml and 43.5 ± 30.2 ml, respectively (p = 0.83), and pouch diameter at the maximal distention was 35.3 ± 5.9 ml (MRI) and 31.0 ± 10.0 ml (CT) (p = 0.16). The rate of ITM was 75% in both examinations (p = 1.0). Conclusion Swallow MRI is a valid method for the assessment of pouch volume in different phases of the swallowing process and is comparable to 3D-CT. The diagnosis of ITM using swallow MRI was equal to 3D-CT.
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