Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity

Papasavas, Pavlos; Caushaj, Philip F.; McCormick, James; Quinlin, Robert; Hayetian, Fernando; Maurer, J.; Kelly, Jamie; Gagné, Daniel J.

doi:10.1007/s00464-002-8826-6

Cited by 151 publications

(85 citation statements)

References 23 publications

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“…The large decrease in mesenteric fat after distal gastrectomy is a major cause of weight loss after surgery [17,18]. As a result, a large weight loss may increase the size of the mesenteric defect, thus accelerating the internal hernia [19].…”

Section: Resultsmentioning

confidence: 99%

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: 99%

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

et al. 2013

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“…Two of the procedures involve a stapled anastomosis with either circular or linear staplers, potentially reducing technical complexity and the duration of the procedure. The reported rates for complications after stapled gastrojejunostomy are 1.1 to 6% for leaks, 2.9 to 27.1% for strictures, and 1.6% for intraluminal bleeding [16][17][18][19][20][21][22][23]. The third accepted technique is the hand-sewn gastrojejunostomy originally promoted by Higa et al [24].…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass

et al. 2010

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Background Traditional laparoscopic surgery presents some difficulties for morbidly obese patients due to limited motion of instruments related to a thick abdominal wall, intraabdominal fat, and a large hepatic left lobe, with consequent loss of dexterity and greater musculoskeletal discomfort. Robotic technique could potentially overcome these limitations. This study aimed to evaluate robot-assisted laparoscopic Roux-en-Y gastric bypass in morbidly obese patients and to compare the results of robotic assistance with those of traditional laparoscopic technique. Methods Between September 2006 and June 2009, 110 morbidly obese patients underwent laparoscopic Roux-en-Y gastric bypass with robot-assisted hand-sewn gastrojejunal anastomosis using the da Vinci Surgical System. The data for these patients was compared with the data for 423 consecutive patients treated in a standard laparoscopic manner during the same period. Results The patients had a mean preoperative age of 42.6 years, a mean weight of 127.5 kg, and a mean body mass index (BMI) of 46.7 kg/m 2 . The total mean operative time was 247.5 min. The robotic setup time was 10.1 min, and the robotic operative time was 54.5 min. The conversion rate was nil. The intraoperative complication rate was 4.5%. The early and late major postoperative complication rates were 3.6 and 6.4% respectively. The cost per patient was 5777.76 €. For the standard laparoscopy, the operative time was significantly shorter (187 min; p < 0.001), and the costs per patient were significantly lower (4658.28 €; p < 0.001), whereas no differences were found in terms of the intra-or postoperative complication rates, revisional surgery, or hospital length of stay. Conclusions Although safe and intuitive, the robotic approach was burdened by a longer operative time and higher equipment costs. Moreover, it did not seem to provide a real advantage over standard laparoscopy in terms of hospital length of stay and complications rates. Keywords Bariatric surgery Gastrojejunal anastomosis Morbid obesity Robot-assisted gastric bypass Robotic surgery Roux-en-Y gastric bypass To date, bariatric surgery is the only long-term effective therapy available for the morbidly obese population [1][2][3]. Over recent decades, laparoscopic surgical techniques have become the gold standard in bariatric surgery due to advantages such as less postoperative pain, shorter hospital stay, faster postoperative recovery, and minimal scarring [4][5][6]. Moreover, for the obese patient, the mini-invasive approach has demonstrated its ability to reduce postoperative mortality [7,8]. However, the inherent limitations of traditional laparoscopic surgery may cause some technical difficulties due to the limited freedom of motion for the instruments related to the thick abdominal wall and hepatomegaly, with consequent loss of dexterity and greater musculoskeletal discomfort for the surgeon [9].

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“…Internal herniation is the most common cause for bowel obstruction after LRYGBP in most series (Table 2). [6][7][8][9][10][11][12][13][14] Higa et al 13 reported that internal herniation occurred in 63 of 2000 patients (3.1%) who underwent LRYGBP. Champion et al 7 reported internal herniation in 6 of 13 bowel obstructions in their series of 711 laparoscopic gastric bypasses.…”

Section: Discussionmentioning

confidence: 99%

“…Others have reported late obstruction at this site as a result of scarring at the transverse mesocolon defect. 7,11 Gould et al 6 reported an obstruction of the Roux limb, which had twisted in the retrocolic tunnel. A twisted Roux limb can result in obstruction and possibly ischemic bowel, resulting in a leak.…”

Section: Discussionmentioning

confidence: 99%

Bowel Obstruction after Laparoscopic Roux-en-Y Gastric Bypass

Nguyen¹,

Huerta²,

Gelfand³

et al. 2004

Obes Surg

119

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Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity

Abstract: A variety of complications can present after LRYGB. Laparoscopy is an excellent technique to treat these complications.

Cited by 151 publications

References 23 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

Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass

Bowel Obstruction after Laparoscopic Roux-en-Y Gastric Bypass

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