title: Complications of gastric bypass: avoiding the Roux-en-O configuration.
abstract: BACKGROUND
  Atypical complications of gastric bypass surgery include the Roux-en-O configuration: an improper connection of the bilio-pancreatic limb to the gastric pouch.
  
  
  METHODS
  Four cases of Roux-en-O, which occurred at institutions not affiliated with the authors, were reviewed for issues related to causation and patient outcomes.
  
  
  RESULTS
  One case was diagnosed intraoperatively (patient 1), while the time of diagnosis in the remaining three patients was postoperative days 2, 52, and 230 (patients 2-4). The delay resulted in two computed tomography scans, two endoscopies, and four contrast studies per patient. These patients presented with protracted biliary emesis and a clinical picture of bowel obstruction. Irrespective of time to diagnosis, all patients endured significant postoperative sequelae-numerous surgeries (n=10, 3, 1, and 3, respectively) and increased length of stay (97, 86, 49, and 125 days, respectively). Patients 2 and 3 were diagnosed by repeat laparotomy, and patient 4 was diagnosed by HIDA scan.
  
  
  CONCLUSIONS
  Nevertheless, surgery remains the most effective means by which to diagnose the problem, as well as correct the complication. Maneuvers that should be employed to prevent this rare complication include keeping the bilio-pancreatic limb short, identifying the ligament of Treitz and marking the Roux limb shortly after jejunal transection.
authors.affiliation: Comprehensive Bariatric Surgery Center, Baylor College of Medicine, 1709 Dryden, Suite 1500, Houston, TX 77030, USA. vsherman@bcm.edu
authors.forename: Vadim
authors.initials: V
authors.lastname: Sherman
authors.forename: Adrian G
authors.initials: AG
authors.lastname: Dan
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Lord
authors.forename: Bipan
authors.initials: B
authors.lastname: Chand
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
mesh_terms: D000328:Adult; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D007902:Length of Stay; D008297:Male; D019300:Medical Errors / Q000009:adverse effects*; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014839:Vomiting / Q000175:diagnosis* / Q000209:etiology*; D055815:Young Adult
chemical_list: D003287:Contrast Media