title: Early jejunojejunostomy obstruction after laparoscopic gastric bypass: case series and treatment algorithm.
abstract: BACKGROUND
  To review our experience with early jejunojejunostomy obstruction (JJO) at a large academic teaching hospital and provide a management algorithm. Early JJO is a known and often overlooked complication of laparoscopic Roux-en-Y gastric bypass.
  
  
  METHODS
  From 2003 to 2007, 1097 patients underwent laparoscopic Roux-en-Y gastric bypass at our institution. Data, including patient demographics, co-morbidities, intraoperative data, peri- and postoperative complications, and outcomes, were prospectively recorded and retrospectively reviewed.
  
  
  RESULTS
  Early post-laparoscopic Roux-en-Y gastric bypass JJO occurred in 13 patients (1.2%). The average time to presentation was 15 days (range 5-27). Patients presented with a combination of nausea, vomiting, and abdominal pain; all underwent computed tomography to confirm the diagnosis. The causes of JJO included dietary noncompliance (46%), anastomotic edema (23%), narrowing of the jejunojejunostomy at surgery (23%), and luminal clot (8%). Management was determined using our proposed treatment algorithm. Three patients (23%) required operative intervention, with the remainder successfully treated conservatively.
  
  
  CONCLUSIONS
  From our experience, we propose a treatment algorithm for standardized management of early JJO, reserving reoperation for those who are acutely ill on presentation or those in whom conservative management fails. A review of our series using this algorithm has suggested that most patients can be successfully treated nonoperatively; however, bariatric surgeons must maintain a low threshold for surgical re-intervention in cases in which rapid recovery is not seen.
authors.affiliation: Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California 90095-6904, USA.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Lewis
authors.forename: Candice
authors.initials: C
authors.lastname: Jensen
authors.forename: Talar
authors.initials: T
authors.lastname: Tejirian
authors.forename: Erik
authors.initials: E
authors.lastname: Dutson
authors.forename: Amir
authors.initials: A
authors.lastname: Mehran
mesh_terms: D000328:Adult; D000465:Algorithms; D005440:Fluid Therapy / Q000379:methods*; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D007441:Intubation, Gastrointestinal / Q000379:methods; D007579:Jejunal Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D007582:Jejunostomy; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome