title: Small bowel obstruction after antecolic and antegastric laparoscopic Roux-en-Y gastric bypass: could the incidence be reduced?
abstract: BACKGROUND
  Small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass (LRYGB) may be related to the surgical technique used. The frequency and characteristics of postoperative SBO were studied in two cohorts of patients after LRYGB.
  
  
  METHODS
  In a 4-year period, 359 patients underwent LRYGB as an initial bariatric operation at our clinic. Patients were divided into two groups. In Group 1 (n = 187), the mesentery of the jejunum was widely divided, the mesenteric defect was closed, and Petersen's space was not sutured. In Group 2 (n = 172), the mesentery was not divided, and both the mesenteric folds and Petersen's space were closed. Episodes of SBO, etiology, treatment, and outcome were analyzed and compared.
  
  
  RESULTS
  There were 141 males and 218 females, with mean age of 41 ± 11 years. Preoperative BMI was 43.2 ± 7 kg/m(2). In Group 1, 29/187 patients (15.5%) developed SBO at a mean follow-up of 15 ± 6.4 months. In Group 2, 2/172 patients (1.1%) developed SBO at 12.3 ± 6.7 months. Internal hernia was responsible for the SBO in 29 patients (19 through the adjacent mesenteric defect and 10 through Petersen's space). Mean EWL at the time of SBO was 82.2 ± 22.7%. SBO was successfully resolved by laparoscopy in 25 patients, conversion was necessary in three, and one was treated by open surgery. One patient presented intestinal perforation after revision.
  
  
  CONCLUSIONS
  Surgical details such as leaving the jejunal mesentery intact and closing all created defects significantly decreased the incidence of SBO due to internal hernias in antecolic antegastric LRYGB.
authors.affiliation: The Obesity Clinic, American British Cowdray Medical Center, Mexico City, Mexico.
authors.forename: Arturo
authors.initials: A
authors.lastname: Rodríguez
authors.forename: Maureen
authors.initials: M
authors.lastname: Mosti
authors.forename: Mauricio
authors.initials: M
authors.lastname: Sierra
authors.forename: Rocío
authors.initials: R
authors.lastname: Pérez-Johnson
authors.forename: Salvador
authors.initials: S
authors.lastname: Flores
authors.forename: Guillermo
authors.initials: G
authors.lastname: Dominguez
authors.forename: Hugo
authors.initials: H
authors.lastname: Sánchez
authors.forename: Artemio
authors.initials: A
authors.lastname: Zarco
authors.forename: Karen
authors.initials: K
authors.lastname: Romay
authors.forename: Miguel F
authors.initials: MF
authors.lastname: Herrera
mesh_terms: D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery
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