In the morbidly obese, laparoscopic Roux-en-Y gastric bypass (LRYGB) effectively achieves weight loss with the resolution of co-morbidities. One of the complications of this procedure is the development of gastro-jejunal anastomotic stricture. The purpose of this study is to compare the effect of post-operative stricture on weight loss.
Methods and procedures
We performed a retrospective review of our prospective database, which included 877 patients who underwent Roux-en-Y gastric bypass over the last 4 years. We compared the patients in the stricture group (SG) to control group (CG), regarding weight loss and demographics. The case matched controls were 42 randomly selected patients without any postoperative stricture of similar demographic characteristics. Student’s t-test was performed to compare the two groups.
Among 877 patients (656 females and 221 males) 21(2.3%) developed stricture (20 females 1 male). Three patients were revisional Roux-en-Y gastric bypass (RRYGB). Out of 42 patients in the control group (40 females 2 males) 6 had RRYGB. Average BMI: SG 50.81 (CG 50.95). Average age: SG 46.59 years (CG 44.07).The average time until the development of stricture was 89 days (range 31- 680 days). The average length of follow-up was 1.5 years (range 6 months to 2.5 years). The average total weight loss: – SG 19.09 % Vs 24.70 % in the CG. (p=0.0154). The average excess weight loss: – SG 37.20% Vs 47.06% in the CG (p=0.043). Multiple dilatations were needed in 10 out of 21 patients with the average being 1.6 dilatations per patient.
Decreased weight loss in patients with postoperative stricture appears counter intuitive. Failure to lose weight in the short term follow-up period (1.5 years) compared to normal patients could be attributed to maladaptive eating habits developed in response to the stricture. Stricture development appears to be a factor that can account for poor weight loss after LRYGB.
Program Number: P032