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Stomal (Anastomotic) Stenosis After Gastric Bypass Surgery

What is stomal stenosis after gastric bypass surgery?

After a gastric bypass procedure for weight loss, some people may develop a narrowing of the new connection between their stomach and lower intestine. This complication is called stomal stenosis, or anastomotic stenosis.

What causes stomal stenosis after gastric bypass surgery?

It's not clear why stomal stenosis occurs after gastric bypass surgery. It may be because of a combination of factors. Some studies suggest that using staples, especially circular staples, poses a greater risk for stenosis than sewing up the stomach by hand after the surgery.

In other cases, scarring or insufficient blood flow to the area is thought to be the cause. Use of excessive aspirin medications or nonsteroidal anti-inflammatory drugs (NSAIDS) can also cause ulceration at the stoma. This can lead to stomal stenosis. This is a condition called ischemia. Vomiting may be a symptom of the complication and is difficult to diagnose.

Who is at risk for stomal stenosis after gastric bypass surgery?

Stomal stenosis typically occurs several weeks after gastric bypass surgery. It can occur later on, but in these instances, it's often accompanied by other problems, such as ulcers at the stoma.  Smoking and NSAIDs, including aspirin, can also be risk factors for stomal stenosis, even long after the weight-loss surgery.

What are the symptoms of stomal stenosis after gastric bypass surgery?

The symptoms of stomal stenosis can include:

  • Food intolerance
  • Nausea
  • Persistent vomiting of undigested food, especially right after eating
  • Difficulty swallowing

How is stomal stenosis after gastric bypass surgery diagnosed?

If you have any of the above symptoms after a gastric bypass procedure, your health care provider may need to do tests to find out if stomal stenosis is the cause. If so, more treatments or surgery may be necessary.

How is stomal stenosis after gastric bypass surgery treated?

The simplest way to fix stomal stenosis is with a procedure called endoscopic dilation. Your doctor will perform an endoscopy and inflate a special balloon into the new connection to your stomach, to make it bigger.

In some cases, additional surgeries might be needed to fix any problems related to stomal stenosis. Proton pump inhibitor therapy might also be useful if you secrete too much acid.

Can stomal stenosis after gastric bypass surgery be prevented?

To help prevent stomal stenosis, follow your health care provider's strict recommendations when it comes to diet and how you eat after a gastric bypass procedure. Discuss the use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDS). Like all weight-loss surgery patients, you will need lifelong monitoring by your health care provider to check for nutritional deficiencies and other potential problems. 

Key points

Some people may develop a narrowing of the new connection between their stomach and lower intestine after gastric bypass surgery.

  • It's not clear why stomal stenosis occurs after gastric bypass surgery.
  • Smoking and nonsteroidal anti-inflammatory drugs (NSAIDS) can be risk factors for stomal stenosis, even long after the weight-loss surgery.
  • Symptoms include:
    • Food intolerance
    • Nausea
    • Persistent vomiting of undigested food ,especially right after eating
    • Difficulty swallowing
  • The simplest way to fix stomal stenosis is with a procedure called endoscopic dilation.
  • To help prevent stomal stenosis, follow your health care provider’s strict recommendations about your diet and how you eat.
  • You will need lifelong monitoring by your health care provider to check for nutritional deficiencies and other potential problems. 

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Online Medical Reviewer: Fincannon, Joy, RN, MN
Online Medical Reviewer: newMentor board-certified, academically affiliated clinician
Last Review Date: 1/29/2014
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