Prevention and Management of Gastro-Jejunostomy Anastomotic Strictures

Jakkapan Wittaya, Narong Boonyakard,

Suthep Udomsawaengsup, and Praveen Raj Palanivelu


A stricture of the gastrojejunal(GJ) anastomosis is one the most common complication after laparoscopic roux-en-Y gastric bypass(LRYGB), ranging from

2.9 to 23 % across numerous studies [1, 2]. An anastomotic stricture has to be suspected if the patient has frequent nausea, emesis and/or dysphagia with liquids or meal. A stricture can be confirmed by the inability to pass the gastroscope (10mm) through the gastrojejunal anastomosis. It usually occurs 1 month after the surgery and can be classified as early or late (within or longer than 30 days after operation, respectively [3]. In this chapter we aim to discuss the different predisposing factors for stricture formation and also the management options.

Predisposing Factors

The risk factors based on existing literature include gastroesophageal reflux disease (GERD), younger age, antecolic construction of GJ, usage of fibrin glue around the anastomosis and usage of 21 mm circular stapler for creation of GJ [4-9].

Blackstone et al. found that young age and GERD were both independent risk factors for development of GJ stricture and that the odds of developing a GJ stricture decreased with increasing age [7]. However, other studies have not confirmed this association [1, 8]. Riberio-Parenti L et al. had shown that the incidence of stricture

J. Wittaya • N. Boonyakard • S. Udomsawaengsup, MD, FACS, FRCST (*)

Chula Minimally Invasive Surgery Center, Chulalongkorn University, Bangkok, Thailand e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

P.R. Palanivelu, MS, DNB, DNB(SGE), FALS, FMAS

Bariatric Division, Upper Gastrointestinal Surgery and Minimal Access Surgery Unit, GEM Hospital and Research Centre, Coimbatore, India e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

© Springer Nature Singapore Pte Ltd. 2017

P.R. Palanivelu et al. (eds.), Bariatric Surgical Practice Guide,

DOI 10.1007/978-981-10-2705-5_26

was more common with antecolic construction of GJ compared to a retrocolic method [9]. This could probably be related to the increased anastomotic tension at the site of GJ. The relationship of the various anastomotic to stricture formations is discussed below.

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