Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass: etiology, diagnosis, and management.
OBJECTIVE
To summarize our experience with small-bowel obstructions after laparoscopic Roux-en-Y gastric bypass.


METHODS
Retrospective record review.


METHODS
University-affiliated hospital.


METHODS
One hundred five consecutive patients undergoing surgery for intestinal obstruction after laparoscopic Roux-en-Y gastric bypass between May 24, 2001, and December 1, 2006.


METHODS
Common presenting symptoms, causes, yield of radiological studies, and types of surgical procedures performed for post-gastric bypass bowel obstruction.


RESULTS
A total of 2325 laparoscopic Roux-en-Y gastric bypass procedures were performed during the study period. A total of 105 patients underwent 111 procedures. Bowel obstruction was confirmed in 102 patients, yielding an overall incidence of 4.4%. The most common presenting symptom was abdominal pain (82.0%), followed by nausea (48.6%) and vomiting (46.8%). Thirty-one patients (27.9%) presented with all of the 3 mentioned symptoms. The mean time to presentation was 313 days after bypass (range, 3-1215 days). Among the studies, results in 48.0% of computed tomographic scans, 55.4% of upper gastrointestinal studies, and 34.8% of plain abdominal radiography studies were positive for intestinal obstruction. In 15 patients (13.5%), all of the radiological study results were negative. The most common causes were internal hernias (53.9%), Roux compression due to mesocolon scarring (20.5%), and adhesions (13.7%). Laparoscopic explorations were carried out in 92 cases (82.9%). The incidences of bowel obstructions were 4.8% with retrocolic Roux placement and 1.8% with antecolic Roux placement.


CONCLUSIONS
Altered gastrointestinal tract anatomy results in vague symptoms and a poor yield with imaging studies. A sound knowledge of altered anatomy is the key to correct interpretation of imaging studies and prompt diagnosis.
Husain
Syed
S
Department of Bariatric Surgery, University of Rochester, Highland Hospital, 1000 South Ave, Rochester, NY 14620, USA.
Ahmed
Ahmed R
AR
Johnson
Joseph
J
Boss
Thad
T
O'Malley
William
W
D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D007421:Intestine, Small; D010535:Laparoscopy / Q000009:adverse effects*; D009767:Obesity, Morbid / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed