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Gastric pouch sero-myotomy for persistent dysphagia after roux-en-Y gastric bypass: Video report

ABSTRACT: Highlights • Dysphagia after roux en Y gastric bypass can be related to problems at the pouch itself.• An initial step in the management should be trial of endoscopic dilalation.• Laparoscopic sero-myotomy is a valid and feasible option for the treatment of proximal gastric stricture.• Revisional operations after sleeve gastrectomy can cause this kind of strictures. Laparoscopic Sleeve Gastrectomy (LSG) is one of the most common bariatric operations done worldwide [1]. About 6.6% of the LSG is being converted to laparoscopic roux-en-Y gastric bypass (LRYGB), most commonly due to inadequate weight loss (65%) and severe reflux (26%) [2]. The most common late complications after LRYGB are dumping, small bowel obstruction, internal hernia, weight regain, marginal ulcer, strictures of the gastro-jejunostomy [3] and rarely proximal stricture at the gastric pouch as our presented case. Treatment options for such a case may start with endoscopic dilatation and if not succeeded it may warrant surgical intervention as shortening of the pouch and redo of the gastrojejunostomy proximal to the stricture or even total gastrectomy and esophago-jejunal anastomosis. Sero-myotomy of the gastric pouch can be done as the same technique which can be used in sero-myotomy of sleeved stomach with stricture [4] and spare resection of the pouch. This report aims to present a new option of surgical management for proximal stricture of the gastric pouch after LRYGB which to our knowledge was never published in the literature.

SUBMITTER: Abu Sneineh M

PROVIDER: S-EPMC7744812 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Project description:IntroductionNo standard of anatomical variables, including stoma size, limb length, pouch size, and volume, has been determined for laparoscopic Roux-en-Y gastric bypass yet. Herein, we evaluated the effect of two different techniques for creating the gastric pouch on short-term postoperative weight loss.MethodsThis retrospective cohort was conducted on patients with a laparoscopic Roux-en-Y gastric bypass history from January 2019 to September 2020. Patients were divided into two groups: in one group, patients' gastric pouch was made using two 60 mm linear staplers, while in the other group, the gastric pouch was made using three 60 mm linear staplers. Anthropometric data, including weight, height, and body mass index (BMI), were measured preoperatively and six months following surgery. Weight outcomes, such as weight loss, a decrease in BMI, excess weight loss (%EWL), and total weight loss (%TWL), were calculated as short-term weight outcomes.ResultsTwo groups, each containing 50 patients, were included. Patients with smaller pouches (two staplers) had 32.4 ± 9.2 kg weight loss, and those with larger pouches (three staplers) had a 31.42 ± 10.3 kg weight loss. Also, %EWL was 69.7 ± 14.9 and 63.0 ± 20.9, and %TWL was 28.2 ± 6.0 and 26.14 ± 7.5 in patients with two stapler pouches and three stapler pouches, respectively. None of the weight outcome parameters were significantly different between the groups (p-value>0.05).ConclusionVarious studies have been conducted, resulting in different conclusions regarding the effect of the size of the gastric pouch on weight loss. One of the major differences contributing to varying literature studies results is the measurement method used for gastric pouch size. We conclude that using two staplers is not a way to achieve a better result. As the best measurement method has not been defined, studies comparing different methods are suggested; here, the aim was to use a more simple and clinical method regarding this issue.

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Gastric pouch sero-myotomy for persistent dysphagia after roux-en-Y gastric bypass: Video report

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