Strictures post-bariatric surgery: Complications of narrowing in the digestive tract

Undergoing bariatric surgery comes with inherent risks such as leaks, bleeding, blood clots, and the development of anastomotic strictures post-bariatric surgery. Anastomotic strictures occur when the surgical connection between the stomach and esophagus becomes constricted.

Patients might experience symptoms such as nausea, vomiting, difficulty swallowing, a sense of fullness in the upper-middle abdomen, and problems consuming certain foods. The exact causes of strictures are not definitively known but are thought to include factors such as the surgical use of staples over sutures, scar tissue formation, reduced blood flow at the surgical site, and ulceration from smoking or NSAID usage.

While strictures are not immediately life-threatening, they can significantly impact quality of life, particularly during meals. Symptoms typically manifest about a month after surgery, although they can emerge up to six months later.

Strictures post-gastric sleeve surgery

The gastric sleeve procedure, which reduces the stomach by approximately 70%, may lead to strictures due to the altered stomach size and shape. This alteration can cause the stomach tube to twist or kink, akin to a garden hose, which disrupts the smooth passage of food through the digestive system. Symptoms usually appear around six months after the operation, often making eating difficult and increasing the likelihood of reflux and vomiting post-meal.

Strictures post-gastric bypass surgery

Gastric bypass surgery is another procedure prone to strictures. This operation creates a small stomach pouch, about the size of an egg, and connects it to the small intestine using sutures or staples. As this connection heals, it may narrow, leading to food feeling stuck or frequent vomiting. Anastomotic strictures are a common complication of gastric bypass, with a significant portion of patients experiencing mild strictures. Early diagnosis via routine endoscopy about one-month post-surgery is critical for effective management.

Diagnosing strictures post-bariatric surgery

Strictures can be diagnosed using radiographic techniques or an upper gastrointestinal (GI) examination. Radiographically, this involves having the patient ingest a contrast solution followed by radiologic observation to detect any slowing or obstruction of the contrast at the upper stomach. Alternatively, an upper endoscopy allows direct visualization of the digestive tract to identify any constrictions. If a stricture is identified, it can often be treated by dilating the narrowed area with a balloon inserted through the endoscope.

In severe cases where dilation is insufficient, further surgery may be necessary to convert a gastric sleeve to a gastric bypass, utilizing a new section of the stomach to create a less constricted pathway.

Both gastric sleeve and gastric bypass patients face risks of developing strictures, but gastric bypass offers easier management options through endoscopic approaches. If you suspect you might be experiencing symptoms indicative of a stricture, consulting with your bariatric care team for a thorough evaluation is advisable.