title: Afferent loop obstruction following laparoscopic distal gastrectomy with Billroth-II gastrojejunostomy.
abstract: OBJECTIVE
  Afferent loop (A-loop) obstruction is an uncommon postgastrectomy complication following Billroth-II (B-II) or Roux-en-Y reconstruction. Moreover, its development after laparoscopic gastrectomy has not been reported. Here we report 4 cases of A-loop obstructions after laparoscopic distal gastrectomy (LDG) with B-II reconstruction.
  
  
  METHODS
  Among the 396 patients who underwent LDG with a B-II anastomosis between April 2004 and December 2011, 4 patients had A-loop obstruction. Their data were obtained from a prospectively maintained institutional database and analyzed for outcomes.
  
  
  RESULTS
  Four patients (1.01%) developed A-loop obstruction. All were male, and their median age was 52 years (range, 30 to 73 years). The interval between the initial gastrectomies and the operation for A-loop obstruction ranged from 4 to 540 days (median, 33 days). All 4 patients had symptoms of vomiting and abdominal pain and were diagnosed by abdominal computed tomographic (CT) scan. The causes of the A-loop obstructions were adhesions (2 cases) and internal herniations (2 cases) that were treated with Braun anastomoses and reduction of the herniated small bowels, respectively. All patients recovered following the emergency operations.
  
  
  CONCLUSIONS
  A-loop obstruction is a rare but serious complication following laparoscopic and open gastrectomy. It should be considered when a patient complains of continuous abdominal pain and/or vomiting after LDG with B-II reconstruction. Prompt CT scan may play an important role in diagnosis and treatment.
authors: Department of Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors: Dong Jin
authors: DJ
authors: Kim
authors: Jun Hyun
authors: JH
authors: Lee
authors: Wook
authors: W
authors: Kim
keywords: Afferent loop obstruction; Billroth-II operation; Ileus; Laparoscopy
references: Ann Surg. 1970 Dec;172(6):996-1001
references: 5496485
references: Korean J Gastroenterol. 2007 Mar;49(3):173-6
references: 18172346
references: Emerg Radiol. 2004 Feb;10(4):201-3
references: 15290491
references: Acta Chir Belg. 2009 Jan-Feb;109(1):101-3
references: 19341207
references: Ann Surg. 1967 Feb;165(2):323-4
references: 6017078
references: J Gastric Cancer. 2011 Jun;11(2):69-77
references: 22076206
references: Hepatogastroenterology. 2005 May-Jun;52(63):680-2
references: 15966181
references: Br J Surg. 1960 Sep;48:183-9
references: 13687665
references: Calif Med. 1950 Jan;72(1):18-21, illust
references: 15398889
references: Arch Surg. 1996 May;131(5):561-5
references: 8624206
references: Radiology. 2000 Jul;216(1):142-5
references: 10887240
references: World J Surg. 2010 Oct;34(10):2389-92
references: 20458583
references: Abdom Imaging. 2003 Sep-Oct;28(5):624-30
references: 14628863
references: J Gastric Cancer. 2011 Sep;11(3):162-6
references: 22076221
references: Gastrointest Endosc. 2002 Apr;55(4):602-5
references: 11923786