Bowel Obstruction after Open and Laparoscopic Gastric Bypass Surgery for Morbid Obesity

Capella, Rafael F.; Iannace, Vincent A.; Capella, Joseph F.

doi:10.1016/j.jamcollsurg.2006.05.301

Cited by 95 publications

(62 citation statements)

References 11 publications

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“…Thus, there is the possibility of internal hernia after laparoscopic distal gastrectomy with R-Y reconstruction. Laparoscopic RYGBP reportedly has a high rate of postoperative internal hernia with an incidence of 3.1 to 9.7 % in laparoscopic surgery [7][8][9]. These authors reported 7.9 to 27 % of internal hernias occurred at Petersen's defect after laparoscopic RY-GBP, with a high bowel resection rate and a mortality rate [7][8][9].…”

Section: Resultsmentioning

confidence: 94%

“…Laparoscopic RYGBP reportedly has a high rate of postoperative internal hernia with an incidence of 3.1 to 9.7 % in laparoscopic surgery [7][8][9]. These authors reported 7.9 to 27 % of internal hernias occurred at Petersen's defect after laparoscopic RY-GBP, with a high bowel resection rate and a mortality rate [7][8][9]. The reason why the incidence of internal hernia is higher in laparoscopic RYGBP may be that laparoscopy decreases tissue trauma and therefore causes fewer adhesions than open surgery [9].…”

Section: Resultsmentioning

confidence: 99%

“…As for the position of the Roux limb, the retrocolic route in laparoscopic RYGBP has three potential sites for internal hernia, namely, the transverse colon mesentery, Petersen's defect, and the enteroenterostomy site [8][9][10]. Recently, many authors have preferred the antecolic route for the Roux limb, which reduces the potential sites for hernia from three to two, including Petersen's defect after a laparoscopic RYGBP [10,20,21].…”

Section: Resultsmentioning

confidence: 99%

“…Studies for complications after RYGBP have reported a significantly higher incidence of long-term internal hernia after laparoscopic surgery than open surgery [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…However, there are only a few reports on the incidence of internal hernia, especially Petersen's hernia, with R-Y reconstruction after laparoscopic distal gastrectomy for cancer [11,12]. This is a matter of concern because these hernias can present dramatically as an acute bowel obstruction with necrosis of the bowel, especially when diagnosis with prompt surgical intervention is delayed [9].…”

Section: Introductionmentioning

confidence: 99%

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Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer

et al. 2013

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Background To decrease the incidence of internal hernia after laparoscopic Roux-en-Y gastric bypass, recent recommendations indicated closure of mesenteric defects and Petersen's defect. Laparoscopic distal gastrectomy for gastric cancer is used increasingly, so the incidence of Petersen's hernia can also increase, but the trend has not been studied. Methods This study retrospectively reviewed 358 consecutive patients who underwent laparoscopic distal gastrectomy for gastric cancer at one institution, with antecolic Roux-en-Y (RY) reconstruction. Results Petersen's hernia occurred in 6 (2.2 %) of 268 patients whose Petersen's defect was not closed by a mean of 351 days after surgery. All the patients underwent reoperation with reduction and repair of the hernia except the first case. In 90 subsequent cases, with closure of the Petersen's defect, internal hernias did not occur (0/90 cases; p = 0.06). Focusing on the totally laparoscopic procedure, Petersen's hernia occurred in 2 (5.1 %) of 39 patients, whereas in 81 subsequent cases, with closure of Petersen's defect, internal hernias did not occur (0/81 cases; p = 0.03). Conclusions Based on the recent recommendations for bariatric surgery, closure of this potential hernia defect is necessary after laparoscopic distal gastrectomy with R-Y reconstruction for gastric cancer.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Studies for complications after RYGBP have reported a significantly higher incidence of long-term internal hernia after laparoscopic surgery than open surgery [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer

et al. 2013

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Small-Bowel Obstruction After Laparoscopic Roux-en-Y Gastric Bypass

Husain

Ahmed²,

Johnson³

et al. 2007

Arch Surg

100

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Setting: University-affiliated hospital. Patients: One hundred five consecutive patients undergoing surgery for intestinal obstruction after laparoscopic Roux-en-Y gastric bypass between May 24, 2001, and December 1, 2006. Main Outcome Measures: Common presenting symptoms, causes, yield of radiological studies, and types of surgical procedures performed for post-gastric bypass bowel obstruction. Results: A total of 2325 laparoscopic Roux-en-Y gastric bypass procedures were performed during the study period. A total of 105 patients underwent 111 procedures. Bowel obstruction was confirmed in 102 patients, yielding an overall incidence of 4.4%. The most common presenting symptom was abdominal pain (82.0%), followed by nausea (48.6%) and vomiting (46.8%). Thirty-one patients (27.9%) presented with all of the 3 mentioned symptoms. The mean time to presentation was 313 days after bypass (range, 3-1215 days). Among the studies, results in 48.0% of computed tomographic scans, 55.4% of upper gastrointestinal studies, and 34.8% of plain abdominal radiography studies were positive for intestinal obstruction. In 15 patients (13.5%), all of the radiological study results were negative. The most common causes were internal hernias (53.9%), Roux compression due to mesocolon scarring (20.5%), and adhesions (13.7%). Laparoscopic explorations were carried out in 92 cases (82.9%). The incidences of bowel obstructions were 4.8% with retrocolic Roux placement and 1.8% with antecolic Roux placement. Conclusions: Altered gastrointestinal tract anatomy results in vague symptoms and a poor yield with imaging studies. A sound knowledge of altered anatomy is the key to correct interpretation of imaging studies and prompt diagnosis.

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Obesity and Bariatric Surgery

Peirce¹,

Ahnfeldt²

2018

Surgical Critical Care and Emergency Surgery

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Bowel Obstruction after Open and Laparoscopic Gastric Bypass Surgery for Morbid Obesity

Cited by 95 publications

References 11 publications

Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer

Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer

Small-Bowel Obstruction After Laparoscopic Roux-en-Y Gastric Bypass

Obesity and Bariatric Surgery

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