Remodeling Of Anastomosis

May 4, 2022

Bariatric surgery is the most effective treatment option for obese patients as it provides significant and sustainable weight loss. Most often bariatric surgery will involve reducing the size of the stomach by placing sutures or staples and creating a new anastomosis or connection between the stomach and the intestines while bypassing a section of the gastrointestinal tract. Despite excellent outcomes from bariatric surgery, anastomotic stenosis, marginal ulcers, and anastomotic leakage may develop which require remodeling of the anastomosis.

An anastomotic stenosis is the narrowing of the new connection between the stomach and the intestine. It is also known as an anastomotic stricture. It may be caused due to scarring, the inadequate blood supply to the area, and certain types of staples. Stenosis usually occurs 3 to 4 weeks after the bariatric surgery. Smoking or the use of nonsteroidal anti-inflammatory medication and aspirin increase your risk of developing stenosis. Symptoms include trouble eating certain foods, difficulty swallowing, a feeling of fullness in the upper and middle abdomen, nausea and vomiting. The stenosis can be treated endoscopically using a special balloon. The endoscope is passed to the area of the stenosis and the balloon is then inflated stretching the opening back to its normal size. In some cases, surgical revision may be required to open the stricture.

A marginal ulcer at the anastomosis presents as a superficial erosion. You may have a sensation of pain and discomfort when food enters the stomach. Marginal ulcers can be treated with antacids and sucralfate liquid which forms a protective coating over the ulcer. In severe cases, the ulcer can bleed and perforate which will require emergency surgical correction.

An anastomotic leak is a severe complication with high morbidity rates and may require a lengthy hospital stay for treatment. It occurs due to the breakdown of the anastomosis. If the leak is detected within 5 days of the bariatric surgery, the primary treatment involves suturing of the defect. In case a leak has been detected more than 5 days following the surgery, the treatment is operative drainage with gastrostomy tube placement.