Background: Elevated rates of small bowel obstruction (SBO)and internal herniation have been reported following laparoscopic Roux-en-Y gastric bypass (LRYG).
Methods: We reviewed our series of LRYGB for the incidence of SBO or internal hernia. The medical records of 409 consecutive patients who underwent LYRGB from April 2004, through November 2007 were reviewed. All procedures were antegastric and antecolic LRYGB, with complete running closure of both mesenteric defects, including closure of the Petersen defect to the margin of the transverse colon. The main outcomes measure was readmission with the diagnosis of small bowel obstruction.
Results: 409 patients underwent LRYGB during the time period examined. 8 admissions for SBO in 7 patients (1.7%) were identified. Mean preoperative BMI was 48.9 ± 7.8 kg/m2. Median time to development of SBO was 5.5 (2-442,IQR=53) days with 5 patients presenting within the first postoperative week. All SBO episodes required re-operation with small bowel resection necessary in 3 episodes (all port site hernias). The causes of SBO at exploration were umbilical port site hernia (n=5), incarcerated ventral hernia from previous laparotomy (n=2), adhesions (n=1). No admissions for SBO with subsequent findings of internal hernia were identified. The mean excess body weight loss in this group was 55.0 ± 17.4% at 1 year.
Conclusion: This study suggests that the incidence of small bowel obstruction secondary to internal herniation following antecolic LRYGB can be minimized by running closure of all mesenteric defects. Most small bowel obstructions in this series were secondary to fascial defects.