Resection or reduction? The dilemma of managing retrograde intussusception after Roux-en-Y gastric bypass.
BACKGROUND
Retrograde intussusception (RI) at the jejunojejunostomy can occur after Roux-en-Y gastric bypass (RYGB). Although this complication is rare, it has been encountered more frequently as the number of bariatric procedures have increased. Little data is available to assist surgeons with the optimal management of this condition. Our objectives were to identify the risk factors for RI after RYGB and report on outcomes after surgical intervention at a tertiary academic surgical unit.


METHODS
We used our prospective longitudinal institutional bariatric surgical database to identify patients with post-RYGB RI from 1996 to 2011.


RESULTS
We identified 28 post-RYGB RI cases. The median interval between RYGB and RI was 52 months, and the median percentage of excess weight loss was 75%. Patients presented with acute symptoms in 36% of the cases. All patients underwent surgical exploration, including resection and revision of the jejunojejunostomy (46%) or operative reduction with or without enteropexy (54%). Those undergoing resection had a longer hospital stay but similar 30-day complication rates. At a median follow-up of 9 months, only 1 recurrence was documented.


CONCLUSIONS
RI is a rare and late complication of RYGB and typically occurs after significant weight loss. In the presence of ischemia or nonreducible RI, resection and revision of the jejunojejunostomy is recommended. In less acute patients, laparoscopic management with reduction and/or enteropexy offers a reduced hospital length of stay while maintaining equivalent morbidity and low recurrence compared with resection.
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Oliver
O
Varban
Ali
A
Ardestani
Dan
D
Azagury
David B
DB
Lautz
Ashley H
AH
Vernon
Malcolm K
MK
Robinson
Ali
A
Tavakkoli
D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D015994:Incidence; D007443:Intussusception / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D007583:Jejunum / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D014057:Tomography, X-Ray Computed