Complications Happen, My Struggle With a Stricture

October 7, 2015

Sitting in the doctor's office and listening to a surgeon go through a litany of possible surgical complications is just that: a list of medical conditions you believe will never happen to you. One percent, three percent, or even five percent of patients experience these side effects. Nope, you're going with the odds: 99%, 98%, and 95% of patients will be fine. So, you barely hear the words coming out of his mouth. You see his lips move, but all you hear is your own heartbeat. You are excited, elated because your weight loss surgery is finally a reality. The words of each complication and its associate percentages do not affect you- at all. It doesn't matter. Why? Because you're focused on the surgery and not its aftermath. But when the complication actually happens to you, it is much more overwhelming than those around you can understand. I had bariatric surgery. I was one of the "percentages" who suffered a complication. I hope this article helps you understand the "not so minor" minor complication called a stricture.

Stricture by definition is a constraint, limitation, restraint, impediment, barrier, or obstacle. In medicine, a stricture is the closure or narrowing of an opening. Strictures can happen to anyone. These strictures are frequently located at the gastro-esophageal junction (where the esophagus attaches to the stomach opening). For the bariatric surgical patient, strictures are commonly located at the new connection between the stomach and small bowel. This type of stricture, a narrowing of this "new" connection, results from newly formed scar tissue; or a "too-tight" surgical connection; or, at times, both of these situations.

A “minor” complication to the medical professional often feels like a huge complication to the patient. Frequently, the patient feels as if he will never get better. As a nurse and a RNY patient who encountered this "minor" complication called a stricture, I am a testament to the fact that those who suffer this type of complication will come out on the other side of it a stronger and healthier person. The emotional upheaval of recovering from surgery, the changing of your addiction to food, and the learning curve necessary for a new way of eating is so overwhelming that any road block seems impassable. Strictures are repairable, but the "fix" may require several procedures and take months.

As a nurse, I knew what having a stricture meant, however I was not prepared for multiple procedures lasting months. My story is not atypical. I'm just like everyone else who has had a stricture post-gastric bypass. I'm sharing my story desiring it gives you hope and the courage to take control of your health.

After months of research, I had a RNY gastric bypass in December of 2009. The immediate recovery period went as well as expected. I was definitely sore and emotional but was able to work though my discomfort and feelings with the support of family, friends, and my surgeon's medical staff. My bariatric program's protocol says to start soft foods in the fourth week after surgery. So I did. I believed the feeling of "being full" as if food was somehow "stuck" in my digestive system was normal and the result of the healing process. I continued trying different soft foods and suffering until even liquids would not pass my stomach.I did not remember ever hearing the word "stricture", so I was surprised when my surgeon told me of this possibility.

I was sent for a CT scan with dye. I vividly remember trying to drink that contrast dye. I felt as if I was attempting to climb Mt. Everest. But, I did it. The diagnosis was now confirmed. Sure enough, I had a stricture. With the diagnosis now in place, it was time for the cure. I had an EGD (esophagogastrduaodenoscopy) in which a scope is inserted into your new stomach to dilate the new opening of the small bowel. It is a simple procedure but never the less stressful. Under sedation, you don't even remember it. I clearly recall being nervous, but also remember feeling hopeful that this procedure would fix the problem. It usually takes more than one procedure to repair a stricture; and, as I discovered, I was certainly no exception no matter how much I hoped for a different outcome.

As the weeks progressed, I underwent a procedure every two weeks for the next several months. Yes, you did read that correctly- five procedures in all. At the time, I thought I was never going to feel better. Supported by my sister, who had also had gastric bypass, I was able to focus on the things I could do and not focus on the things I could not change. This process took more patience and determination than I thought I possessed. After the third EGD and dilation, I made the decision to look elsewhere for a cure. My surgeon was amazing. My surgeon still is amazing. I just had a nagging feeling that someone else may be more skilled at the actual dilation procedure than he might be. As wonderful at the RNY procedure as he was, dilations were not his specialty.

Remember, as patients, we have choices for our care. We are ultimately in charge.

A thirteen year veteran nurse of day surgery, I knew a lot of surgeons. I reached out to the most skilled physician I knew for EGD’s, Dr. Al-Sabbagh. I met with him and reviewed my medical history. He made a plan for my recovery and cure. From a nurse’s perspective, please understand that getting a second opinion is not an insult to your surgeon. We have the right to find the most skilled professionals available to handle our care. My surgeon was more than successful at bariatric procedures and the head of the program where my surgery was performed, but endoscopy was not his specialty.

Dr. Al-Sabbagh decided it was best to do the fourth dilation in a slightly different way. While the scope was in my stomach, he was going to inject a steroid drug into the four quadrants of the scar tissue causing the stricture. I came back for an additional EGD to be sure his plan was working. He was also able to be more aggressive on the dilation, going up to a larger dilating balloon, because he had had prior experience using this technique. After three months and five dilations, the stricture was cured!

During this three month process, I remember feeling like I would never recover and feel healthy again. It was not until I focused on what I could change that I was able to move forward. I focused on hydration and rest and not on how many calories I was taking in or how many vitamin doses I had missed. While very important to your long term recovery, these things can be put aside while focusing on lifesaving measures.

My message is simple, research and listen to the possible complications. Know that they are real! You must be prepared for the lifelong recovery of weight loss surgery. Losing weight quickly is not the goal. Doing it the healthy way is. I lost 125 pounds and have kept 90% of it off for almost 6 years, but I will never forget my struggle with a stricture.



Audra Brosnahan, RN is a post-surgical nurse at Duke Hospital. She is a native of the Raleigh area and is passionate in her belief in self improvement. Audra made her to decision to undergo gastric- bypass surgery in December of 2009 and has successfully maintained over a one hundred pound weight loss. Although her journey was marked by post surgical complications, Audra overcame these and has a passion to help others face reality and live successfully. She truly believes that each person writes his or her own success story!