Surgical management of obstructing clot at the jejunojejunostomy after gastric bypass: a single center experience and literature review

Hess, Donald T.; Beesley, Hassan; Carter, Cullen O.; Carmine, Brian; Pernar, Luise I.M.

doi:10.1016/j.soard.2020.11.020

Cited by 3 publications

(4 citation statements)

References 22 publications

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“…Other authors reported type 2 diabetes [2], older age, and hypertension [19] along with renal insufficiency, preoperative therapeutic anticoagulation, and revisional surgery [20], which was not found in our study. Most of the patients with bleeding at the JJ had a symptomatology of intestinal obstruction due to an obstructive clot, leading to the distension of the excluded stomach and dilatation of the biliary limb [21]. Left undiagnosed, this complication carries a significant risk of blow-out of the gastric remnant.…”

Section: Discussionmentioning

confidence: 99%

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Early Bleeding After Laparoscopic Roux-en-Y Gastric Bypass: Incidence, Risk Factors, and Management — a 21-Year Experience

et al. 2022

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Purpose Morbidity and mortality associated with bariatric surgery are considered low. The aim of this study is to assess the incidence, clinical presentation, risk factors, and management of early postoperative bleeding (POB) after laparoscopic Roux-en-Y gastric by-pass (RYGB). Materials and Methods Retrospective analysis of prospectively collected data of consecutive patients who underwent RYGB in 2 expert bariatric centers between January 1999 and April 2020, with a common bariatric surgeon. Results A total of 2639 patients underwent RYGB and were included in the study. POB occurred in 72 patients (2.7%). Intraluminal bleeding (ILB) was present in 52 (72%) patients and extra-luminal bleeding (ELB) in 20 (28%) patients. POB took place within the first 3 postoperative days in 79% of patients. The most frequent symptom was tachycardia (63%). Abdominal pain was more regularly seen with ILB, compared to ELB (50% vs. 20%, respectively, p = 0.02). Male sex was an independent risk factor of POB on multivariate analysis (p < 0.01). LOS was significantly longer in patients who developed POB (8.3 vs. 3.8 days, p < 0.01). Management was conservative for most cases (68%). Eighteen patients with ILB (35%) and 5 patients with ELB (25%) required reoperation. One patient died from multiorgan failure after staple-line dehiscence of the excluded stomach (mortality 0.04%). Conclusion The incidence of POB is low, yet it is the most frequent postoperative complication after RYGB. Most POB can be managed conservatively while surgical treatment is required for patients with hemodynamic instability or signs of intestinal obstruction due to an intraluminal clot. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

“…Most of the patients with bleeding at the JJ had a symptomatology of intestinal obstruction due to an obstructive clot, leading to the distension of the excluded stomach and dilatation of the biliary limb [ 21 ]. Left undiagnosed, this complication carries a significant risk of blow-out of the gastric remnant.…”

Section: Discussionmentioning

confidence: 99%

Early Bleeding After Laparoscopic Roux-en-Y Gastric Bypass: Incidence, Risk Factors, and Management — a 21-Year Experience

et al. 2022

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“… 11 , 12 , 13 , 14 In spite of these, patients still commonly experience dissatisfied survivals. 15 Therefore, finding biomarkers for monitoring the progression and prognosis of gastric cancer is important for more accurate treatment and better prognosis.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, a huge number of studies are devoted to making contributions to the treatment for advanced gastric patients including chemotherapy, targeted therapy, and immunotherapy 11‐14 . In spite of these, patients still commonly experience dissatisfied survivals 15 …”

Section: Introductionmentioning

confidence: 99%

Circular RNA mitochondrial translation optimization 1 correlates with less lymph node metastasis, longer disease‐free survival, and higher chemotherapy sensitivity in gastric cancer

Chang

Zheng

Wang

et al. 2022

Clinical Laboratory Analysis

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Objective Circular‐mitochondrial translation optimization 1 (circ‐MTO1) inhibits the progression of gastric cancer by regulating the growth, apoptosis, and invasion of tumor cells. However, its clinical potential as a biomarker for gastric cancer remains to be further evaluated. This study aimed to assess circ‐MTO1 expression and its correlation with clinical features and prognosis in gastric cancer patients, as well as the effect of circ‐MTO1 on the sensitivity to chemotherapy in gastric cancer cells. Methods Circ‐MTO1 in tumor and adjacent tissues of 97 gastric cancer patients undergoing resection was examined by reverse transcription‐quantitative polymerase chain reaction. HGC‐27 and NCI‐N87 cells transfected by circ‐MOT1 overexpression plasmid (OE‐circ‐MOT1) and negative control (OE‐NC) were treated with 0‒6.4 μM oxaliplatin. Relative cell viability was detected using Cell Counting Kit‐8. Results Circ‐MTO1 was insufficiently expressed in gastric tumor tissue (median (interquartile range): 0.403 (0.288‒0.518)) compared with adjacent tissue (median (interquartile range): 1.000 (0.715‒1.524)) ( p < 0.001). Besides, tumor circ‐MTO1 was correlated with less lymph node metastasis ( p = 0.014) and low TNM stage ( p = 0.039), while was not correlated with demographic features or other clinical characteristics (all p > 0.05). Furthermore, tumor circ‐MTO1 high expression was independently correlated with prolonged disease‐free survival (DFS) ( p = 0.013, adjusted hazard ratio (95% confidential interval): 0.314 (0.126‒0.782)), but was not correlated with overall survival ( p > 0.05). Lastly, in gastric cancer cells, OE‐circ‐MTO1 apparently decreased relative cell viabilities at oxaliplatin concentrations of 0.4, 0.8, 1.6, and 3.2 μM (all p < 0.05). Conclusion Circ‐MTO1 correlates with less lymph node metastasis, prolonged DFS, and improved chemotherapy sensitivity in gastric cancer.

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Non-operative Management of Obstructing Clot at the Jejunojejunal Anastomosis Site After Laparoscopic Roux-en-Y Gastric Bypass: a Case Report

2021

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Surgical management of obstructing clot at the jejunojejunostomy after gastric bypass: a single center experience and literature review

Cited by 3 publications

References 22 publications

Early Bleeding After Laparoscopic Roux-en-Y Gastric Bypass: Incidence, Risk Factors, and Management — a 21-Year Experience

Early Bleeding After Laparoscopic Roux-en-Y Gastric Bypass: Incidence, Risk Factors, and Management — a 21-Year Experience

Circular RNA mitochondrial translation optimization 1 correlates with less lymph node metastasis, longer disease‐free survival, and higher chemotherapy sensitivity in gastric cancer

Non-operative Management of Obstructing Clot at the Jejunojejunal Anastomosis Site After Laparoscopic Roux-en-Y Gastric Bypass: a Case Report

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