A Retrospective Study of Management of Gastric Stenosis Post Laparoscopic Sleeve Gastrectomy, Our Institution Experience

Abstract

Abstract Background Bariatric surgery is the only obesity treatment with long-term efficacy. Of the various surgical techniques available, laparoscopic sleeve gastrectomy (LSG) is becoming increasingly popular because of its good weight loss results, its ability to correct comorbidities associated with obesity, and its low post-operative complication rate. The early-onset complications of LSG (i.e., those that appear in the first three post- operative months) include gastric fistula (in 2.5 % of cases, according to a recent meta-analysis) and hemorrhage (in fewer than 5 % of cases). Stenosis is a less frequently described early-onset complication of LSG, with an incidence of 0.69 to 3.5%. Objective To evaluate different strategies of management of post LSG stenosis and the benefit affecting patient's morbidity and mortality and to describe the mechanism of stenosis and its treatment, suggest a standardized approach to management of post-LSG GS on this basis. Patients and Methods This study is a retrospective discreptive study which included patients underwent Laparoscopic sleeve gastrectomy (LSG) at Ain-Shams University El-Demerdash Hospital, Cairo, Egypt and specialized bariatric centers under the supervision of the study modulatrors, Cairo, Egypt From September 2018 to September 2019 with six months of postoperative follow up till January 2020. Results In this study we have revised the data of one thousand patients performed laparoscopic sleeve gastrectomy in our bariatric surgery departement and showed a rate of stenosis of 1%, the mean age was 37.5, mean BMI was 47.9, 5 cases were treated by balloon dilatation, two of the were diagnose as stricture and the other three were diagnosed as twist, another two cases were managed by RYGB, and two cases were managed by MGB, finally one case was conservatively managed along with thiamine deficiency support. Conclusion Gastric stenosis is a rare but potentially life-threatening complication of LSG. Endoscopic treatment (balloon dilatation in particular) is effective, safe, and avoids the need for revisional surgery. If three attempts at dilatation fail, surgery is necessary. Nutritional support and vitamin supplementation are necessary in cases of poor oral feeding with recurrent vomiting.