What Is Stomal Stenosis in Gastric Bypass?
According to the American Academy of Family Physicians, 67 percent of Americans are obese or overweight. Obesity is linked to serious health risks such as cardiovascular disease, diabetes and osteoarthritis and costs $117 billion a year. Many facing these risks are choosing weight-loss surgeries, such as Roux-en-Y gastric bypass or RYGB which is the most common. These surgeries have risks as well, and one of the most prevalent is stomal stenosis.
Gastric Bypass
In RYGB surgeons create a stomach pouch and a bypassed malabsorptive section of small intestine. Other procedures may involve simply restrictive measures. The results with RYGB include a restriction on how much the stomach comfortably holds and how much is absorbed. The intended and typical result is weight loss. RYGB is a serious procedure with a risk of mortality at 1 percent and risk of serious complications at 10 percent. Stomal stenosis is basically when the connection between the stomach and the bypass is too tight.
Stomal Stenosis
Stomal stenosis occurs in about 9 to 20 percent of RYGB patients. The majority of patients present with stomal stenosis within a few months after surgery. The major symptom of the condition is persistent vomiting even after a simple liquid diet intake. Not considered one of the more serious potential side effects of gastric bypass surgery, it's a late complication that is readily diagnosed and treated. In most cases it does not require further surgery.
Considerations
Patients who undergo RYGB are at particular risk for nutritional deficiencies, and if stomal stenosis occurs, the risks are considerably higher. Patients should be advised to follow a high protein diet and take multivitamins with iron, b 12, and calcium. To prevent vomiting, patients should cut food into small bites, thoroughly chew food before swallowing, eating slowly and not drinking any liquids until at least one hour after meals, according to American Family Physician.
Treatment
To diagnose stomal stenosis, physicians will perform an upper gastrointestinal endoscopy, where a small lighted tube is inserted through the mouth into the affected area. If the doctor is unable to insert the 9-mm endoscope through the stoma and no ulceration in the area is observed, balloon dilation is performed. It takes on average 2.1 tries with the balloon procedure before the situation is resolved. The physician will first try with a 13-mm balloon, and go up to 16 or possibly 18 mm in opening the restricted area.
Complications
Treatment with endoscopic balloon dilation is usually successful, with only about 3 percent of patients returning with stomal stenosis again. A small risk of perforation exists with the procedure. If endoscopy doesn't work, surgery is typically the next option for the patient.
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