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01.10.2010 | Clinical Research

Small Bowel Obstruction After Antecolic and Antegastric Laparoscopic Roux-en-Y Gastric Bypass: Could the Incidence be Reduced?

verfasst von: Arturo Rodríguez, Maureen Mosti, Mauricio Sierra, Rocío Pérez-Johnson, Salvador Flores, Guillermo Dominguez, Hugo Sánchez, Artemio Zarco, Karen Romay, Miguel F. Herrera

Erschienen in: Obesity Surgery | Ausgabe 10/2010

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Abstract

Background

Small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass (LRYGB) may be related to the surgical technique used. The frequency and characteristics of postoperative SBO were studied in two cohorts of patients after LRYGB.

Methods

In a 4-year period, 359 patients underwent LRYGB as an initial bariatric operation at our clinic. Patients were divided into two groups. In Group 1 (n = 187), the mesentery of the jejunum was widely divided, the mesenteric defect was closed, and Petersen’s space was not sutured. In Group 2 (n = 172), the mesentery was not divided, and both the mesenteric folds and Petersen’s space were closed. Episodes of SBO, etiology, treatment, and outcome were analyzed and compared.

Results

There were 141 males and 218 females, with mean age of 41 ± 11 years. Preoperative BMI was 43.2 ± 7 kg/m2. In Group 1, 29/187 patients (15.5%) developed SBO at a mean follow-up of 15 ± 6.4 months. In Group 2, 2/172 patients (1.1%) developed SBO at 12.3 ± 6.7 months. Internal hernia was responsible for the SBO in 29 patients (19 through the adjacent mesenteric defect and 10 through Petersen’s space). Mean EWL at the time of SBO was 82.2 ± 22.7%. SBO was successfully resolved by laparoscopy in 25 patients, conversion was necessary in three, and one was treated by open surgery. One patient presented intestinal perforation after revision.

Conclusions

Surgical details such as leaving the jejunal mesentery intact and closing all created defects significantly decreased the incidence of SBO due to internal hernias in antecolic antegastric LRYGB.
Literatur
1.
Zurück zum Zitat Sjöström L, Narbrok K, Sjöström D, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.CrossRefPubMed Sjöström L, Narbrok K, Sjöström D, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.CrossRefPubMed
2.
Zurück zum Zitat Sugerman HJ, Kellum JM, Engle KM, et al. Gastric bypass for treating severe obesity. Am J Clin Nutr. 1992;55:560S–6.PubMed Sugerman HJ, Kellum JM, Engle KM, et al. Gastric bypass for treating severe obesity. Am J Clin Nutr. 1992;55:560S–6.PubMed
3.
Zurück zum Zitat Benotti PN, Forse RA. The role of gastric surgery in the multidisciplinary management of severe obesity. Am J Surg. 1995;169:361–7.CrossRefPubMed Benotti PN, Forse RA. The role of gastric surgery in the multidisciplinary management of severe obesity. Am J Surg. 1995;169:361–7.CrossRefPubMed
4.
Zurück zum Zitat DeMaria EJ, Sugerman HJ, Kellum JM, et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg. 2002;235:640–5.CrossRefPubMed DeMaria EJ, Sugerman HJ, Kellum JM, et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg. 2002;235:640–5.CrossRefPubMed
5.
Zurück zum Zitat Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass. A review of 3464 cases. Arch Surg. 2003;138:957–61.CrossRefPubMed Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass. A review of 3464 cases. Arch Surg. 2003;138:957–61.CrossRefPubMed
6.
Zurück zum Zitat Capella RF, Iannace VA, Capella JF, et al. Bowel obstruction after open and laparoscopic gastric bypass surgery for morbid obesity. J Am Coll Surg. 2006;203:328–35.CrossRefPubMed Capella RF, Iannace VA, Capella JF, et al. Bowel obstruction after open and laparoscopic gastric bypass surgery for morbid obesity. J Am Coll Surg. 2006;203:328–35.CrossRefPubMed
7.
Zurück zum Zitat Champion JK, Williams M. Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:596–600.CrossRefPubMed Champion JK, Williams M. Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:596–600.CrossRefPubMed
8.
Zurück zum Zitat Blachar A, Federle MP, Pealer KM, et al. Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology. 2002;223:625–32.CrossRefPubMed Blachar A, Federle MP, Pealer KM, et al. Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology. 2002;223:625–32.CrossRefPubMed
9.
Zurück zum Zitat Dresel A, Kuhn JA, Westmoreland MV, et al. Establishing a laparoscopic gastric bypass program. Am J Surg. 2002;184:617–20.CrossRefPubMed Dresel A, Kuhn JA, Westmoreland MV, et al. Establishing a laparoscopic gastric bypass program. Am J Surg. 2002;184:617–20.CrossRefPubMed
10.
Zurück zum Zitat Felsher J, Brodsky J, Brody F, et al. Small bowel obstruction, after laparoscopic Roux-en-Y gastric bypass. Surgery. 2003;134:501–5.CrossRefPubMed Felsher J, Brodsky J, Brody F, et al. Small bowel obstruction, after laparoscopic Roux-en-Y gastric bypass. Surgery. 2003;134:501–5.CrossRefPubMed
11.
Zurück zum Zitat Nguyen NT, Huerta S, Gelfand D, et al. Bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2004;14:190–6.CrossRefPubMed Nguyen NT, Huerta S, Gelfand D, et al. Bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2004;14:190–6.CrossRefPubMed
12.
Zurück zum Zitat Lujan JA, Frutos MD, Hernandez Q, et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a randomized prospective study. Ann Surg. 2004;239:433–7.CrossRefPubMed Lujan JA, Frutos MD, Hernandez Q, et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a randomized prospective study. Ann Surg. 2004;239:433–7.CrossRefPubMed
13.
Zurück zum Zitat Cho MC, Carrodeguas L, Pinto D, et al. Diagnosis and management of partial small bowel obstruction after laparoscopic antecolic antegastric Roux-en-Y gastric bypass for morbid obesity. J Am Coll Surg. 2006;202:262–8.CrossRefPubMed Cho MC, Carrodeguas L, Pinto D, et al. Diagnosis and management of partial small bowel obstruction after laparoscopic antecolic antegastric Roux-en-Y gastric bypass for morbid obesity. J Am Coll Surg. 2006;202:262–8.CrossRefPubMed
14.
Zurück zum Zitat Reynolds SF, Heffner J. Airway management of the critically ill patient rapid sequence intubation. Chest. 2005;127:1397–412.CrossRefPubMed Reynolds SF, Heffner J. Airway management of the critically ill patient rapid sequence intubation. Chest. 2005;127:1397–412.CrossRefPubMed
15.
Zurück zum Zitat Rogula T, Yenumula PR, Schauer PR, et al. A complication of Roux-en-Y gastric bypass: intestinal obstruction. Surg Endosc. 2007;21:1914–8.CrossRefPubMed Rogula T, Yenumula PR, Schauer PR, et al. A complication of Roux-en-Y gastric bypass: intestinal obstruction. Surg Endosc. 2007;21:1914–8.CrossRefPubMed
16.
Zurück zum Zitat Hwang RF, Swartz DE, Felix EL, et al. Causes of bowel obstruction after laparoscopic gastric bypass. Surg Endosc. 2004;18:1631–5.PubMed Hwang RF, Swartz DE, Felix EL, et al. Causes of bowel obstruction after laparoscopic gastric bypass. Surg Endosc. 2004;18:1631–5.PubMed
17.
Zurück zum Zitat Escalona A, Devaud N, Pérez G, et al. Antecolic versus retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass: a comparative study. Surg Obes Rel Dis. 2007;3:423–7.CrossRef Escalona A, Devaud N, Pérez G, et al. Antecolic versus retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass: a comparative study. Surg Obes Rel Dis. 2007;3:423–7.CrossRef
18.
Zurück zum Zitat Higa KD, Boone KB, Ho T, et al. Complications of the laparoscopic Roux-en-Y gastric bypass: 1, 040 patients—what have we learned? Obes Surg. 2000;10:509–13.CrossRefPubMed Higa KD, Boone KB, Ho T, et al. Complications of the laparoscopic Roux-en-Y gastric bypass: 1, 040 patients—what have we learned? Obes Surg. 2000;10:509–13.CrossRefPubMed
19.
Zurück zum Zitat Higa KD, Ho T, Boone KB, et al. Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Techn. 2001;11:377–82.CrossRef Higa KD, Ho T, Boone KB, et al. Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Techn. 2001;11:377–82.CrossRef
20.
Zurück zum Zitat Higa KD, Ho T, Boone KB, et al. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003;13:350–4.CrossRefPubMed Higa KD, Ho T, Boone KB, et al. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003;13:350–4.CrossRefPubMed
21.
Zurück zum Zitat Lopez PP, Patel NAA, Koche LS, et al. Outpatient complications encountered following Roux-en-Y gastric bypass. Med Clin North Am. 2007;91:471–83.CrossRefPubMed Lopez PP, Patel NAA, Koche LS, et al. Outpatient complications encountered following Roux-en-Y gastric bypass. Med Clin North Am. 2007;91:471–83.CrossRefPubMed
22.
Zurück zum Zitat Papasavas PK, Caushaj PF, McCornick JT, et al. Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2003;17:610–4.CrossRefPubMed Papasavas PK, Caushaj PF, McCornick JT, et al. Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2003;17:610–4.CrossRefPubMed
23.
Zurück zum Zitat Koppman JS, Li C, Gandsas A, et al. Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass: a review of 9,527 patients. J Am Coll Surg. 2008;206:571–84.CrossRefPubMed Koppman JS, Li C, Gandsas A, et al. Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass: a review of 9,527 patients. J Am Coll Surg. 2008;206:571–84.CrossRefPubMed
Metadaten
Titel
Small Bowel Obstruction After Antecolic and Antegastric Laparoscopic Roux-en-Y Gastric Bypass: Could the Incidence be Reduced?
verfasst von
Arturo Rodríguez
Maureen Mosti
Mauricio Sierra
Rocío Pérez-Johnson
Salvador Flores
Guillermo Dominguez
Hugo Sánchez
Artemio Zarco
Karen Romay
Miguel F. Herrera
Publikationsdatum
01.10.2010
Verlag
Springer-Verlag
Erschienen in
Obesity Surgery / Ausgabe 10/2010
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-010-0164-5

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