title: Late perforation at the jejuno-jejunal anastomosis after laparoscopic gastric bypass for morbid obesity.
abstract: BACKGROUND
  Although marginal ulceration and perforation at the gastrojejunal anastomosis is an established, albeit rare, risk after laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity, little is known about the risk of late perforation at the jejuno-jejunal (J-J) anastomosis. The objective of this study was to identify the incidence of J-J perforation and describe management options and sequelae.
  
  
  METHODS
  This is a retrospective review of the database of all patients who underwent LRYGB. The results are presented as mean (range) where appropriate.
  
  
  RESULTS
  Between April 2002 and April 2012, 1652 patients underwent LRYGB (1577 primary and 75 revision procedures). The operative mortality was .18%. Three patients developed late perforation of the J-J anastomosis (.18%) at 7, 9, and 18 weeks, respectively. Two patients were managed with resection and reanastomosis of the perforation by laparotomy, and a third patient was managed laparoscopically with peritoneal lavage and transcutaneous tube jejunostomy of the perforation. All patients recovered well postoperatively. However, the third patient represented 42 days later with sepsis and died secondary to recurrent J-J ulcer perforation.
  
  
  CONCLUSIONS
  Perforation of the J-J anastomosis is a rare and life-threatening delayed complication after LRYGB and usually presents within 2-8 months postoperatively. It poses difficulties with diagnosis and management and should be dealt with judiciously.
authors: Salford Royal Hospital, Manchester, United Kingdom.
authors: Ramya
authors: R
authors: Kalaiselvan
authors: Mahmoud
authors: M
authors: Abu Dakka
authors: Basil J
authors: BJ
authors: Ammori
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D007583:Jejunum; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
keywords: Bariatric surgery; Gastric bypass; Jejuno-jejunal perforation; Laparoscopic; Marginal ulcer; Perforation