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

Abstract

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.

Imaging in bariatric surgery: service set-up, post-operative anatomy and complications

“…On fluoroscopy, contrast material is seen in a distended alimentary limb ( Figure 5). It can also result in distension of the biliopancreatic limb with air-fluid levels within the Small-bowel obstruction is reported in 4-5% of patients [18]. It is usually caused by internal hernias or adhesions, although other causes include mesocolic window stenosis, bezoar formation in the gastric pouch and intussusception [11,12].…”

“…Compared with open procedures, the laparoscopic approach has reduced the prevalence of adhesions but has led to an increase in the prevalence of internal hernia formation. Internal hernias often develop through the opening in transverse mesocolon following retrocolic placement of the roux limb, and antecolic placement appears to have decreased the prevalence of internal hernias [18]. The herniated bowel is usually the Roux limb itself with a varying amount of additional small-bowel loops [12].…”

Esophageal dysmotility and abscess formation post Roux-en-Y bariatric surgery: A case report

“…The timing of obstruction is highly variable, but one study suggests an average onset of 7-19 days postoperatively for jejunojejunostomy obstructions [7]. Another study suggests a mean time to presentation of 313 days after Roux-en-Y bypass [8]. The most common cause of obstruction, occurring in 42-54% of cases is due to internal hernias [2,7,8].…”

“…Another study suggests a mean time to presentation of 313 days after Roux-en-Y bypass [8]. The most common cause of obstruction, occurring in 42-54% of cases is due to internal hernias [2,7,8]. These are caused by defects in the mesentery created during the operation.…”

Evaluating the Effect of Drain Site on Abdominal Pain after Laparoscopic Gastric Bypass Surgery for Morbid Obesity: A Randomized Controlled Trial

“…14 In laparoscopic Roux-en-Y gastric bypass surgery, the authors state that the postsurgical abdominal pain might be related not only to the drain site but also to other etiologies, as different etiologies have been proposed to contribute to postsurgical abdominal pain, including rapid abdominal distension due to fast eating, 13 food intolerance and nutritional deficiency, 15 gastrointestinal dysfunction, 16,17 or changes in Oddi sphincter function due to gallbladder stones. 18 Gastric ulcer, 19,20 gastroesophageal reflux disease, 1,21,22 and stenosis in the anastomotic site may cause pain in 5-10% of patients, 23,24 trocar site hernia in 0-1%, adhesion band in 1-2%, 25,26 incisional hernia in 1-9%, 23,24 and intussusception in 1%. 26 Omental torsion, infarction, 27,28 and bezoar obstruction 29,30 are other suggested causes.…”