title: Bowel obstruction rates in antecolic/antegastric versus retrocolic/retrogastric Roux limb gastric bypass: a meta-analysis.
abstract: BACKGROUND
  Previous literature is varied with regard to rates of bowel obstruction after laparoscopic Roux-en-Y gastric bypass (LRYGB). Internal herniation through mesenteric defects is a common cause of bowel obstructions. There are advantages and disadvantages to routing the Roux limb via a retrocolic/retrogastric (RC/RG) versus an antecolic/antegastric (AC/AG) position.
  
  
  OBJECTIVE
  To review the literature comparing obstruction rates in RYGB using the antecolic versus retrocolic approach.
  
  
  METHODS
  Community-based integrated multispecialty health system with a teaching hospital serving 19 counties over a 3-state region.
  
  
  METHODS
  A literature search for articles published from 1994-2013 was completed. Articles were included if they reported an n>25, Roux limb route, obstruction rate by route, and follow-up duration. Statistical analysis included χ(2) test by patient number.
  
  
  RESULTS
  The initial search identified 241 articles; 8 met inclusion criteria. There were 4805 patients in the AC/AG group, and 2238 in the RC/RG group. Follow-up ranged from 0 to 68 months. A linear stapled technique was reported in 4231 (88%) patients in the AC/AG group and 1541 (69%) of RC/RG group. Handsewn closure of mesenteric defects was reported in 2152 (45%) patients in the AC/AG group and 1012 (45%) patients in the RC/RG group. Bowel obstructions occurred in 68 (1.4%) patients in the AC/AG group and 117 (5.2%) patients in the RC/RG group (P<.001). Internal hernias were reported in 65 (1.3%) patients in the AC/AG group and 52 (2.3%) patients in the RC/RG group (P<.001). Two mortalities were reported in the AC/AG group.
  
  
  CONCLUSIONS
  Increased rates of bowel obstruction and internal hernia were observed in the RC/RG group compared with the AC/AG group. A prospective, randomized trial would be necessary to definitively determine the impact of Roux limb position and routine closure of mesenteric defects on bowel obstruction rates after gastric bypass.
authors.affiliation: Department of Medical Education, Gundersen Medical Foundation, La Crosse, Wisconsin.
authors.forename: Ayman B
authors.initials: AB
authors.lastname: Al Harakeh
authors.affiliation: Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin.
authors.forename: Kara J
authors.initials: KJ
authors.lastname: Kallies
authors.affiliation: Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Borgert
authors.affiliation: Department of General and Vascular Surgery, Gundersen Health System, La Crosse, Wisconsin. Electronic address: snkothar@gundersenhealth.org.
authors.forename: Shanu N
authors.initials: SN
authors.lastname: Kothari
mesh_terms: D003106:Colon; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods*; D014943:Global Health; D006801:Humans; D015994:Incidence; D007415:Intestinal Obstruction / Q000453:epidemiology* / Q000209:etiology; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D013270:Stomach
keywords: Antecolic; Antegastric; Bowel obstruction; Gastric bypass; Internal hernia; Postoperative complications; Retrocolic; Retrogastric; Roux-en-Y; Surgical technique