title: Bowel obstruction after laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Bowel obstruction has been frequently reported after laparoscopic Roux-en-Y gastric bypass (LRYGBP). The aim of this study was to review our experience with bowel obstruction following LRYGBP, specifically examining its etiology and management and to strategize maneuvers to minimize this complication.
  
  
  METHODS
  We retrospectively reviewed the charts of 9 patients who developed postoperative bowel obstruction after LRYGBP. Each chart was reviewed for demographics, timing of bowel obstruction from the primary operation, etiology of obstruction, and management.
  
  
  RESULTS
  9 of our initial 225 patients (4%) who underwent LRYGBP developed postoperative bowel obstruction. The mean age was 46 +/- 12 years, with mean BMI 47 +/- 9 kg/m(2). 6 patients developed early bowel obstruction, and 3 patients developed late bowel obstruction. The mean time interval for development of early bowel obstruction was 16 +/-16 days. The causes for early bowel obstruction included narrowing of the jejunojenunostomy anastomosis (n=3), angulation of the Roux limb (n=2), and obstruction of the Roux limb at the level of the transverse mesocolon (n=1). The mean time interval for development of late bowel obstruction was 7.4 +/- 0.5 months. The causes for late bowel obstruction included internal herniation (n=2) and adhesions (n=1). 6 of 9 bowel obstructions (66%) were considered technically related to the learning curve of the laparoscopic approach. Eight of the 9 patients required operative intervention, and 6 of the 8 reoperations were managed laparoscopically. Management included laparoscopic bypass of the jejunojejunostomy obstruction site (n=5), open reduction of internal hernia (n=2), and laparoscopic lysis of adhesion (n=1).
  
  
  CONCLUSIONS
  Bowel obstruction is a frequent complication after LRYGBP, particularly during the learn ing curve of the laparoscopic approach. Specific measures should be instituted to minimize bowel obstruction after LRYGBP as most of these complications are considered technically preventable.
authors.affiliation: Department of Surgery, University of California, Irvine Medical Center, Orange, CA 92868, USA. ninhn@uci.edu
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
authors.forename: Sergio
authors.initials: S
authors.lastname: Huerta
authors.forename: Dmitri
authors.initials: D
authors.lastname: Gelfand
authors.forename: C Melinda
authors.initials: CM
authors.lastname: Stevens
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jim
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D002983:Clinical Competence; D004766:Enterostomy / Q000379:methods; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000628:therapy*; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D013997:Time Factors