Spectrum and treatment of small bowel obstruction after Roux-en-Y gastric bypass.
BACKGROUND
Small bowel obstruction (SBO) is a well-recognized complication of bariatric surgery. Many factors that play a role in the etiology of SBO affect the presentation, timing, and treatment after Roux-en-Y gastric bypass (RYGB). We reviewed our experience with SBO after open and laparoscopic RYGB.


METHODS
We reviewed prospectively collected data from 784 consecutive patients who had undergone RYGB (458 open and 326 laparoscopic) from July 1998 to March 2005. The operative techniques were standardized, including closure of the mesenteric defects. The follow-up data were taken from clinic visit records and follow-up questionnaires. The mean follow-up period was 16 +/- 1 months (range 1-75). The data presented are the mean +/- SEM.


RESULTS
The overall incidence of SBO after RYGB was 3.2%. Thirteen patients developed SBO after laparoscopic RYGB (4%) and 12 patients did so after open RYGB (2.6%, P = NS). Obstruction at the jejunojejunostomy was more common after laparoscopic RYGB (77%, P <.05), and adhesive SBO was more common after open RYGB (50%, P <.05). The incidence of SBO from internal hernia was low, regardless of the operative approach (open 0.7% versus laparoscopic 0.3%). Early SBO resolved with nonoperative treatment in 30% of patients.


CONCLUSIONS
Understanding the anatomic considerations of RYGB in the development of SBO after open and laparoscopic approach is essential to timely and effective treatment.
Nelson
Lana G
LG
Department of Surgery, Interdisciplinary Obesity Treatment Group, University of South Florida Health Sciences Center, USF College of Medicine, c/o Tampa General Hospital, Tampa, FL 33601, USA.
Gonzalez
Rodrigo
R
Haines
Krista
K
Gallagher
Scott F
SF
Murr
Michel M
MM
D019992:Databases as Topic; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006555:Hernia, Ventral / Q000150:complications / Q000209:etiology; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology*; D007421:Intestine, Small; D007582:Jejunostomy; D010535:Laparoscopy; D011446:Prospective Studies; D013997:Time Factors; D000267:Tissue Adhesions / Q000209:etiology