Gastrojejunal anastomotic stenosis in laparoscopic gastric bypass with a circular stapler (21 mm): incidence, treatment and long-term follow-up

Obes Surg. 2009 Dec;19(12):1631-35. doi: 10.1007/s11695-009-9962-z.


Background: 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.

Methods: 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.

Results: 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/m2 (range, 34-78 kg/m2). 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.

Conclusions: 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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anastomosis, Roux-en-Y*
  • Catheterization / methods
  • Constriction, Pathologic / etiology
  • Constriction, Pathologic / therapy
  • Female
  • Gastric Bypass / adverse effects*
  • Humans
  • Incidence
  • Jejunal Diseases / epidemiology
  • Jejunal Diseases / etiology
  • Jejunal Diseases / therapy*
  • Laparoscopy / methods
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Complications / therapy*
  • Stomach Diseases / epidemiology
  • Stomach Diseases / etiology
  • Stomach Diseases / therapy*
  • Surgical Staplers
  • Surgical Stapling / adverse effects*
  • Treatment Outcome
  • Young Adult