Sleeve Gastrectomy Incisura Strictures: An Avoidable Catastrophe

Ran B Luo, MD, Shanglei Liu, MD, Jonathan C DeLong, MD, Alisa M Coker, MD, Caitlin Houghton, MD, Bryan J Sandler, MD, FACS, Garth R Jacobsen, MD, FACS, Santiago Horgan, MD, FACS. University of California, San Diego

This video demonstrates the laparoscopic management of an incisura stricture after a sleeve gastrectomy. The patient is a 61 year-old woman who underwent a laparoscopic sleeve Gastrectomy at an outside institution. Unfortunately, she developed a stricture at the level of the incisura, leading to dysphagia and chronic abdominal pain. Initial attempts at endoscopic treatment with balloon dilation and stenting proved unsuccessful, and she was taken for laparoscopic revision. The key steps of initial lysis of adhesions, resection of the stricture, creation of a new gastro-gastric anastomosis with the circular stapler, pre and postoperative endoscopy, as well as pre and post-operative fluoroscopic studies are shown and described. Then, briefly shown are our own techniques of sleeve gastrectomies with emphasis on stricture prevention at the incisura, staple-line plication, and finally endoscopic confirmation of a patent lumen.

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