Abstract
BackgroundThe optimal treatment of sleeve strictures has not been agreed upon at the current time. At our institution, we began using pneumatic balloon dilation to help resolve these obstructions in 2010. Herein we report our experience with pneumatic balloon dilation for the treatment of sleeve strictures.MethodsFrom Jan 2010 to Dec 2016 we retrospectively reviewed our prospectively kept database for patients who developed a Laparoscopic Sleeve Gastrectomy (LSG) stricture within 90 days of surgery. If the stricture was found, then we dilated all our patients initially at 30 mm at 10 PSI for 10-20 min (14.5 min average) and increased the balloon size (30-40 mm) and duration (10-30 min) in subsequent sessions if the first session was unsuccessful.ResultsThe review found that 1756 patients underwent either LSG or the first step of a Laparoscopic Duodenal Switch (LDS) (1409 LSG & 356 LDS). Of the 1756 patient 33 patients (24 underwent LSG, and 9 underwent LDS) developed a stricture as a complication of LSG. The average age of the patients was 46.4 (±9.6) years, and the average BMI was 43.7 (±6.4). The most common location for stricture was mid-body of the sleeve (54.5%). The average time from the primary surgery to diagnosis and first pneumatic dilation was 5.6 months (± 6.8) and 5.9 months (± 6.6) respectively. We successfully used pneumatic dilation in 31 (93.9%) of these patients to relieve the stricture.ConclusionWe conclude that pneumatic dilation is an effective procedure in patients with post sleeve gastrectomy stricture.
Highlights
The optimal treatment of sleeve strictures has not been agreed upon at the current time
We present a sustainable management plan using pneumatic balloon dilation as the primary modality of treatment for laparoscopic sleeve gastrectomy (LSG) strictures
Thirty-three patients (1.8%) that presented with dysphagia, nausea, vomiting, or food intolerance after LSG or Laparoscopic Duodenal Switch (LDS) with documented stricture on endoscopy or upper gastrointestinal (UGI) contrast study were considered eligible for pneumatic dilation
Summary
The optimal treatment of sleeve strictures has not been agreed upon at the current time. Prevalence of laparoscopic sleeve gastrectomy (LSG) for morbid obesity increased from 0 to 37% of the total world interventions for weight loss surgery between 2003 and 2013 [1] This increase in popularity is attributed to its lower complication rates and safety as a procedure [2]. Patients with early strictures present within the first few weeks following the surgery complaining of dysphagia, vomiting, food intolerance, rapid weight loss, and regurgitation of either food or saliva. These are often pseudo strictures caused either as a result of post-operative edema or hematoma formation
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