Transoral outlet reduction: could additional sutures cause more harm?

Endoscopy. 2021 Oct;53(10):1059-1064. doi: 10.1055/a-1325-4324. Epub 2021 Feb 8.

Abstract

Background: The double purse-string pattern (DPSP) of transoral outlet reduction (TORe) should conceivably result in a more robust scaffolding for the gastrojejunal anastomosis (GJA). However, there is a paucity of literature pertaining to post-TORe stenosis as an adverse event. Our aim was to determine the rate of stenosis, its potential predictors, and other complications of DPSP TORe.

Methods: We performed a retrospective analysis of a prospectively maintained database of 129 consecutive patients who underwent DPSP TORe between December 2015 and August 2019.

Results: The adverse event rate of TORe was 17.1 % (n = 22), with a 13.3 % (n = 17) rate of stenosis. Stenosis was not significantly associated with any baseline characteristics. GJA diameter pre- and post-TORe, the difference between these values, and procedure duration were not predictive of stenosis. Of patients who developed stenosis, 10 (58.8 %) responded to endoscopic balloon dilation and 7 (41.2 %) required stent placement.

Conclusion: As the DPSP technique is a challenging procedure, with high complication rate and limited benefit, it should not be used for TORe.

MeSH terms

  • Gastric Bypass*
  • Humans
  • Obesity, Morbid* / surgery
  • Retrospective Studies
  • Suture Techniques
  • Sutures
  • Treatment Outcome
  • Weight Gain