Abstract
Roux-en-Y gastric bypass (RYGB) is the second most widely used bariatric surgical procedure for morbid obesity and its related comorbidities. Anastomotic stricture is one of the major complications after RYGB. Submucosal tunneling is a rare cause of anastomotic stricture or occlusion, and clinical symptoms will appear soon after surgery. We present our technical suggestions to perform a hand-sewn gastrojejunostomy in situ when the gastric pouch is too small and the tissue is not enough to be resected to solve acute anastomotic stricture due to submucosal tunneling in gastric bypass.
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The data that support the findings of this study are available from the authors upon reasonable request.
References
Welbourn R, Hollyman M, Kinsman R, et al. Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the Fourth IFSO Global Registry Report 2018. Obes Surg. 2019;29(3):782–95.
Carrodeguas L, Szomstein S, Zundel N, et al. Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass surgery: analysis of 1291 patients. Surg Obes Relat Dis. 2006;2(2):92–7.
Almby K, Edholm D. Anastomotic strictures after Roux-en-Y gastric bypass: a cohort study from the Scandinavian Obesity Surgery Registry. Obes Surg. 2019;29(1):172–7.
Torrent-Jansàansentrez-Xaus M, Casajoana A, et al. Pitfall in bariatric laporoscopic surgery: submucosal tunneling in gastric bypass anastomosis intraoperative detection and repair. Obes Surg. 2022;32(5):1786–7.
Vines L, Frick T, Aczéczes L, et al. Aczin gastric bypass anastomosis intraoperative detection and repairsis of 1291 patients ang) declare that they have no conflict of interest. Langenbecks Arch Surg. 2017;402(6):911–6.
Sundaresan N, Hiticas BA, Sullivan M, et al. Gastrojejunal anastomotic stricture following Roux-en-Y gastric bypass: an analysis of anastomotic technique at a single institution. Obes Surg. 2021;31(11):4947–52.
Al Hadad M, Dehni N, Elamin D, et al. Intraoperative endoscopy decreases postoperative complications in laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2015;25(9):1711–5.
Acknowledgements
The authors would like to thank all of the involved study investigators, staffs, clinicians, nurses, and technicians for dedicating their time and skills to the completion of this study.
Funding
National Key Technologies R&D Program (2015BAI13B09); Capital Health Development and Research Key Project (2020–1-2021).
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Key Points
1. Submucosal tunneling is difficult to detect intraoperatively and can be challenging to treatment.
2. Hand-sewn gastrojejunostomy in situ may be an effective method for resolving submucosal tunneling.
3. It is more important to find the correct position, use appropriate techniques, and avoid acute anastomotic stricture due to submucosal tunneling.
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Zhang, Y., Bian, S., Li, M. et al. Hand-Sewn Gastrojejunostomy In Situ to Solve Acute Anastomotic Stricture Due to Submucosal Tunneling in Gastric Bypass. OBES SURG 33, 1622–1624 (2023). https://doi.org/10.1007/s11695-023-06533-2
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DOI: https://doi.org/10.1007/s11695-023-06533-2