title: Surgical treatment of retrograde peristalsis following laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Retrograde Roux limb peristalsis following laparoscopic Roux-en-Y gastric bypass is a rare complication that can be difficult to identify. It may present as persistent nausea, vomiting, abdominal pain, or even gastrointestinal bleeding related to an anastomotic ulcer.  Upper gastrointestinal (UGI) series is an important diagnostic modality to identify this motility disorder; however, it may not be readily identifiable without specific delayed imaging. The etiology of this phenomenon is unclear, but attributing factors include the presence of ectopic pacemaker  cells, variable lengths of the Roux limb and misconstructions. When this problem is identified, revisional surgery is indicated.
  
  
  METHODS
  A 51-y-old female with morbid obesity presented with persistent nausea and vomiting following a laparoscopic gastric bypass. A CT scan  showed a dilated Roux limb. Reverse peristalsis from the jejunojejunostomy toward the gastric pouch was identified on a UGI. Two laparoscopic revisions of the jejunojunostomy were attempted to correct this dysfunction.
  
  
  CONCLUSIONS
  An attempt at widening and relaxing the anastomosis  was unsuccessful at providing relief of symptoms. A second revision with an anastomosis between the Roux limb and common channel provided long-term improvement. Identifying complications of gastric bypass surgery can be challenging. Imaging studies may be limited, and often diagnostic and  revisional surgery is indicated.
authors: University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine, Stratford, NJ, USA. sanderch@umdnj.edu
authors: Christina M
authors: CM
authors: Sanders
authors: Marc
authors: M
authors: Neff
authors: Louis
authors: L
authors: Balsama
mesh_terms: D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007579:Jejunal Diseases / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D007582:Jejunostomy; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D010528:Peristalsis; D011183:Postoperative Complications; D012086:Reoperation