Stricture After Sleeve Gastrectomy

Stricture after sleeve gastrectomy

In sleeve gastrectomy, which is the most commonly used bariatric surgery method today, the stomach volume is reduced by approximately 80% with vertical gastrectomy and a new stomach is formed as a thin tube. A shape called a calibration tube is used, which is inserted orally during the operation in order for the new stomach not to be too stricture during operation. It is ensured that the new stomach does not have too much stricture and that there is no problem in the passage of food. In some cases, strictures may be seen in some areas of the new stomach due to excessive healing tissue. Another cause that may reduce the passage of food is the possibility of twisting that may be seen in the stomach. Especially in patients with more intense gastric angulation, the stomach may turn around due to rapid food intake and functional strictures may be seen due to this. Although this is not a actual stricture in the stomach, it may cause nausea and vomiting in the patient. In particular, precautions are taken against stomach rotation by suturing the newly formed stomach wall to the surrounding fat tissues during surgery.
How is stricture determined? What are the indications?
It is typical to experience nausea and vomiting in the first 24-48 hours after sleeve gastrectomy due to surgery and anesthesia. Then, nutrition stages will begin gradually. Especially in the first 3 months, occasional vomiting may be seen due to the patient’s inability to get used to the new conditions and the sensitivity to certain food groups. Some patients do not experience nausea and vomiting at all. Same surgery may cause different reactions in different patients. As of the 6th month of the surgery, it is not typical to experience ever lasting nausea, rapid occlusion, the feeling of food staying between the chest when you eat fast, and vomiting. When such complaints are seen, you should visit the clinic where your surgery was performed for stricture.
How is stricture determined?
Stricture is one of the long-term complications that may be seen in 2-3% of sleeve gastrectomies. In the diagnosis, the patient’s complaints should be carefully evaluated. It should be researched in detail whether the patient’s complaints are seen in cases where the patient swallows without chewing well or when eating fast. Complaints may be controlled with simple adjustments to eating habits. If stricture is still suspected, further evaluation with gastric emptying and endoscopy is required.
How is the stricture after gastric tube treated?
If the stricture affects the daily life of the patient and causes nutritional problems, it must be treated. In some cases, the patient’s complaints may decrease even with endoscopy. In cases where the stricture is more serious, that can be enlarged with endoscopic balloon dilatations, or in resistant cases, sleeve gastrectomy may need to be revised as to gastric bypass surgery as a revision surgery. The treatment should be planned with the patient in accordance with the patient’s complaints and expectations.