2005 Abstracts: Small Bowel Obstruction Following Laparoscopic Roux En-Y Gastric Bypass:Lessons Learned From 714 Cases
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Small Bowel Obstruction Following Laparoscopic Roux En-Y Gastric Bypass:Lessons Learned From 714 Cases
Andras Sandor, Patrick McEnaney, Liam A. Haveran, Richard A. Perugini, Donald R. Czerniach, Demetrius E. Litwin, John J. Kelly, University of Massachusetts Medical School/UMassMemorial Healthcare, Worcester, MA
Background: Small bowel obstruction (SBO) following laparoscopic Roux en-Y gastric bypass (LGBP) is infrequently encountered. Early recognition and high degree of suspicion are vital to prevent bowel ischemia and necrosis. The aim of our study was to evaluate the correlation between the time interval from LGBP and the underlying cause of SBO in our series.
Methods: Prospectively collected data in a tertiary care academic medical center entered into a patient database was retrospectively reviewed.714 consecutive pts with a mean BMI of 51.2 underwent antecolic/antegastric LGBP for morbid obesity between 6/30/99 and 11/22/04. Mean follow-up period (F/U) was 22.2 months. Results:32 pts (4.5%) required treatment for SBO (25 females; 7 males; mean age 44 yrs). The cause of symptoms included:1. Chronic adhesion formation n=6 (18.8%), (mean time interval form LGBP 225 days, required laparoscopic lysis of adhesions and/or straightening of the jejuno-jejunal anastomosis);2. Postoperative ileus n=5 (15.6%), (mean interval 4.2 days, all resolved with conservative treatment);3. Incarcerated abdominal wall hernia in pre-existing defects n=5 (15.6%), (mean interval 21.6 days, all underwent laparoscopic repair);4. Internal hernia n=9 (28.1%), (mean interval 436 days, 7 pts underwent laparoscopic/2 pt open repair); 5. Jejuno-jejunal anastomotic stricture n=3 (12.5%, mean interval 8 days, all required revision of the anastomosis);6. Acute adhesions n=3 (9%), (mean interval 4 days, all pts underwent laparoscopic LOA);7. Bezoar formation in distal ileum n=1 (34 months, required conversion to open surgery). The diagnosis was based on clinical findings only (n=5) or combined with imaging studies (CT scan with oral contrast n=16; plain abdominal film n=5; upper GI series n=7). Conclusion: SBO following LGBP exhibit a bi-modal occurrence. Those present early following LGBP are from techincal error, acute adhesions or postoperative ileus. SBO caused by chronic adhesion and internal hernia become symptomatic after many months/years following surgery. With more and more patients being followed over a prolonged period of time, we expect to see more of the latter complications in the future.
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