title: Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity.
abstract: 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.
authors.affiliation: Department of Surgery, Temple University Clinical Campus at the Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA.
authors.forename: P K
authors.initials: PK
authors.lastname: Papasavas
authors.forename: P F
authors.initials: PF
authors.lastname: Caushaj
authors.forename: J T
authors.initials: JT
authors.lastname: McCormick
authors.forename: R F
authors.initials: RF
authors.lastname: Quinlin
authors.forename: F D
authors.initials: FD
authors.lastname: Hayetian
authors.forename: J
authors.initials: J
authors.lastname: Maurer
authors.forename: J J
authors.initials: JJ
authors.lastname: Kelly
authors.forename: D J
authors.initials: DJ
authors.lastname: Gagné
mesh_terms: 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