Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity.
BACKGROUND
We reviewed our experience with complications following laparoscopic Roux-en-Y gastric bypass (LRYGB) that were managed laparoscopically.


METHODS
A total of 246 consecutive morbidly obese patients (mean body mass index, 50.9 kg/m2) underwent LRYGB by three surgeons at two institutions. All patients met National Institutes of Health criteria for surgical treatment of morbid obesity. Patients were followed prospectively.


RESULTS
A total of 62 patients (25.2%) developed 64 complications, 34 of which (13.8%) required a surgical intervention. Twenty-seven of the 34 procedures were performed laparoscopically. Gastrojejunostomy stricture was the most common complication (8.9%), followed by intestinal obstruction (7.3%) and gastrointestinal bleeding (4%). The intestinal obstruction was secondary to adhesions (n = 6), internal hernia at the level of the transverse mesocolon (n = 3), jejunojejunostomy stricture (n = 3), and cicatrix around the Roux limb at the level of the transverse mesocolon (n = 3). Other complications included gastrojejunostomy leak (1.6%), symptomatic gallstone disease (2.8%), and gastric remnant perforation (0.8%). One patient underwent a negative laparoscopy to rule out anastomotic leak. There were 3 deaths in this series of patients, 2 attributable to anastomotic leak.


CONCLUSIONS
A variety of complications can present after LRYGB. Laparoscopy is an excellent technique to treat these complications.
Papasavas
P K
PK
Department of Surgery, Temple University Clinical Campus at the Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA.
Caushaj
P F
PF
McCormick
J T
JT
Quinlin
R F
RF
Hayetian
F D
FD
Maurer
J
J
Kelly
J J
JJ
Gagné
D J
DJ
D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects* / Q000379:methods; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome