title: Errant and unrecognized antiperistaltic Roux limb construction during Roux-en-Y gastric bypass for clinically significant obesity.
abstract: BACKGROUND
  Proper isoperistaltic orientation of the Roux limb is important. We report on 5 patients with errant anatomic construction of the Roux limb during Roux-en-Y gastric bypass for clinically significant obesity.
  
  
  METHODS
  We performed a retrospective review of the medical records of these 5 patients. Of the 5 patients, 3 had undergone open and 2 laparoscopic Roux-en-Y gastric bypass.
  
  
  RESULTS
  These 5 patients developed persistent and predominantly bilious vomiting in the immediate postoperative period, with subsequent protein-calorie malnutrition. At least 18 operations were undertaken in these 5 patients at different times to correct the abnormally dilated Roux limb to no avail. The diagnosis of an antiperistaltic anatomy was unsuspected, and these operations failed to address the errant anatomy of the Roux limb or resolve the symptoms. Definitive treatment involved repositioning of the Roux limb in an isoperistaltic direction, which resulted in immediate resolution of the symptoms and reversal of the protein-calorie malnutrition.
  
  
  CONCLUSIONS
  Antiperistaltic Roux anatomy is deleterious, and repositioning of the Roux limb in an isoperistaltic direction will resolve the symptoms and associated protein-calorie malnutrition.
authors.affiliation: Department of Surgery, University of South Florida Health Sciences Center, Tampa, Florida, USA.
authors.forename: Lana G
authors.initials: LG
authors.lastname: Nelson
authors.forename: Michael G
authors.initials: MG
authors.lastname: Sarr
authors.forename: Michel M
authors.initials: MM
authors.lastname: Murr
mesh_terms: D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D010528:Peristalsis; D012086:Reoperation