title: Jejunojejunal anastomotic obstruction following laparoscopic Roux-en-Y gastric bypass due to non-absorbable suture: a report of seven cases.
abstract: BACKGROUND
  Small bowel obstruction (SBO) is a well-known complication of laparoscopic Roux-en-Y gastric bypass (LRYGBP). We describe 7 cases of jejunojejunal anastomotic obstruction related to adhesion formation after closure of the mesenteric "leaves" defect with non-absorbable suture.
  
  
  METHODS
  All patients undergoing LRYGBP from October 2002 until February 2005 were entered into a prospective, longitudinal database. All patients who subsequently presented with SBO were analyzed.
  
  
  RESULTS
  Jejunojejunal anastomotic obstruction occurred in 7 out of 152 patients (4.6%) in whom LRYGBP was performed from October 2002 to February 2004. Since February 2004, the suture used to close the jejunojejunal mesenteric leaves defect was changed from non-absorbable Dacron (Surgidac) to absorbable suture material. The mean interval between initial LRYGBP and subsequent SBO was 153 days. Operative findings common to all 7 cases were dilated loops of proximal small bowel, and a single adhesion just distal to the Roux-Y anastomosis. Following adhesiolysis, each patient had prompt return of bowel function without recurrence of obstruction. Of the 156 patients who have since undergone LRYGBP, none have presented with SBO, and this difference is statistically significant (P=0.008).
  
  
  CONCLUSIONS
  The overall rate of SBO (2.3%) is consistent with the previous literature, although the incidence of adhesions specifically at the jejunojejunal anastomosis is higher than that previously encountered. It appears that the incidence of postoperative SBO at the jejunojejunal anastomosis is directly linked to the choice of suture material intraoperatively. As such, absorbable suture should be used to close the jejunojejunal mesenteric leaves defect.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Gumbs
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Duffy
authors.forename: Rohit
authors.initials: R
authors.lastname: Chandwani
authors.forename: Robert L
authors.initials: RL
authors.lastname: Bell
mesh_terms: D000328:Adult; D001672:Biocompatible Materials / Q000009:adverse effects*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery; D007579:Jejunal Diseases / Q000209:etiology* / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates / Q000009:adverse effects*; D013537:Sutures / Q000009:adverse effects; D000267:Tissue Adhesions / Q000209:etiology / Q000601:surgery
chemical_list: D001672:Biocompatible Materials; D011093:Polyethylene Terephthalates