title: Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass: etiology, diagnosis, and management.
abstract: 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.
authors.affiliation: Department of Bariatric Surgery, University of Rochester, Highland Hospital, 1000 South Ave, Rochester, NY 14620, USA.
authors.forename: Syed
authors.initials: S
authors.lastname: Husain
authors.forename: Ahmed R
authors.initials: AR
authors.lastname: Ahmed
authors.forename: Joseph
authors.initials: J
authors.lastname: Johnson
authors.forename: Thad
authors.initials: T
authors.lastname: Boss
authors.forename: William
authors.initials: W
authors.lastname: O'Malley
mesh_terms: 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