Late perforation of the jejuno-jejunal anastomosis after laparoscopic Roux-en-Y gastric bypass.
Roux-en-Y gastric bypass (RYGBP) is the most commonly performed operation for the treatment of morbid obesity in the USA. Complications related to the jejuno-jejunal (J-J) anastomosis include postoperative leak, staple-line bleeding and obstruction. We present 3 cases of perforation at the J-J anastomosis occurring more than 30 days after surgery. 3 morbidly obese patients underwent laparoscopic RYGBP. The side-to-side J-J anastomosis was created with a linear stapler, and the anastomotic defect was closed with a running absorbable suture. All 3 patients had uneventful recoveries, but presented 7 to 8 weeks postoperatively with acute abdominal pain and peritoneal signs. Exploratory laparoscopy in these patients revealed a perforation at the J-J anastomosis. No apparent reason for the perforation was found in 2 patients. These perforations were repaired laparoscopically with absorbable suture. The third patient had an obstruction at the J-J anastomosis from an phytobezoar and required conversion to open technique due to limited pneumoperitoneum. All 3 patients recovered uneventfully. Late perforation of the J-J anastomosis is a very rare complication. Primary laparoscopic repair is a feasible and safe choice of treatment.
Temple University School of Medicine, The Western Pennsylvania Hospital, Pittsburgh, PA, USA.
David
D
Goitein
Pavlos K
PK
Papasavas
Daniel J
DJ
Gagné
Philip F
PF
Caushaj
D000328:Adult; D000714:Anastomosis, Surgical; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D007583:Jejunum / Q000601:surgery; D008875:Middle Aged; D013997:Time Factors