Abstract
Background
Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass is not a rare complication, occurring in approximately 3% of patients. The goal of this study was to review the causes and timing of small bowel obstruction as an aid to diagnosis, treatment, and prevention.
Methods
The records of consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass at the authors' center from 4/99 to 7/03 were retrospectively reviewed. All the patients had a laparoscopic handsewn gastrojejunostomy and a stapled jejunojejunostomy. The Roux limb was placed retrocolically in the first 405 patients and antecolically in the next 1,310 patients.
Results
Altogether, 1,715 patients underwent a total laparoscopic Roux-en-Y gastric bypass at the authors' bariatric center. In 51 patients, 55 small bowel obstructions occurred (3%) during a median follow-up period of 21 months (range, 1–52 months). Small bowel obstruction developed in 27 (7%) of the retrocolic patients, as compared with 24 (2%) of the antecolic patients (p < 0.001, chi-square). The causes of small bowel obstruction were adhesive bands (n = 14), obstruction at the jejunojejunostomy from kinking or narrowing (n = 13), internal hernia or external compression at the transverse mesocolon (n = 11), internal hernia through the jejunal mesentery (n = 8) incarcerated abdominal wall hernia (n = 4), and other (n = 5). For patients in whom small bowel obstruction developed in the first 3 weeks after their bypass surgery bowel resection was required in 19 of 24 patients, as compared with 6 of 31 patients in whom obstruction develop after 3 weeks (p < 0.001, chi-square).
Conclusions
Early small bowel obstructions tend to result from technical problems with the Roux limb and require revision of the bypass or small bowel resection significantly more often than late obstructions. The latter group of obstructions usually result from adhesions or hernias, which could be handled laparoscopically without bowel resection. The position of the Roux limb (retrocolic vs antecolic) appeared to influence the incidence of small bowel obstruction. In the current series, changing the position of the jejunal bypass limb from retrocolic to antecolic significantly decreased the overall incidence of small bowel obstruction because it eliminated one of the most common sites for obstruction: the mesocolon.
Similar content being viewed by others
References
A Blachar MP Federle KM Pealer S Ikramuddin PR Schauer (2002) ArticleTitleGastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings Radiology 223 625–632 Occurrence Handle12034927
JK Champion M Williams (2003) ArticleTitleSmall bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass Obes Surg 13 596–600 Occurrence Handle10.1381/096089203322190808 Occurrence Handle12935361
GA Colditz (1999) ArticleTitleEconomic costs of obesity and inactivity Med Sci Sports Exerc 31 IssueIDSuppl 11 S663–S667 Occurrence Handle10.1097/00005768-199911001-00026 Occurrence Handle10593542
DR Cottam PJ Gorecki M Curvelo et al. (2002) ArticleTitlePreperitoneal herniation into a laparoscopic port site without a fascial defect Obes Surg 12 121–123 Occurrence Handle10.1381/096089202321144702 Occurrence Handle11868288
EJ DeMaria HJ Sugerman JM Kellum et al. (2002) ArticleTitleResults of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity Ann Surg 235 640–647 Occurrence Handle10.1097/00000658-200205000-00005 Occurrence Handle11981209
GM Eid SG Mattar G Hamad et al. (2004) ArticleTitleRepair of ventral hernias in morbidly obese patients undergoing laparoscopic gastric bypass should not be deferred Surg Endosc 18 207–210 Occurrence Handle10.1007/s00464-003-8915-1 Occurrence Handle14691700
EL Felix DE Swartz (2003) ArticleTitleConversion of laparoscopic Roux-en-Y gastric bypass Am J Surg 186 648–651 Occurrence Handle10.1016/j.amjsurg.2003.08.008 Occurrence Handle14672773
J Felsher J Brodsky F Brody (2003) ArticleTitleSmall bowel obstruction after laparoscopic Roux-en-Y gastric bypass Surgery 134 501–505 Occurrence Handle10.1067/S0039-6060(03)00251-4 Occurrence Handle14555940
JE Filip SG Mattar SP Bowers CD Smith (2002) ArticleTitleInternal hernia formation after laparoscopic Roux-en-Y gastric bypass for morbid obesity Am Surg 68 640–643 Occurrence Handle12132750
KM Flegal MD Carroll CL Ogden CL Johnson (2002) ArticleTitlePrevalence and trends in obesity among U.S. adults, 1999–2000 JAMA 288 1723–1727 Occurrence Handle10.1001/jama.288.14.1723 Occurrence Handle12365955
KD Higa T Ho KB Boone (2003) ArticleTitleInternal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment, and prevention Obes Surg 13 350–354 Occurrence Handle10.1381/096089203765887642 Occurrence Handle12841892
EH Livingston (2002) ArticleTitleObesity and its surgical management Am J Surg 184 103–113 Occurrence Handle10.1016/S0002-9610(02)00914-5 Occurrence Handle12169352
BD Matthews BT Heniford RF Sing (2001) ArticleTitlePreperitoneal Richter hernia after a laparoscopic gastric bypass Surg Laparosc Endosc Percutan Tech 11 47–49 Occurrence Handle10.1097/00019509-200102000-00013 Occurrence Handle11269556
InstitutionalAuthorNameNational Institutes of Health Consensus Development Conference (1992) ArticleTitleGastrointestinal surgery for severe obesity Am J Clin Nutr 55 615s–619s
NT Nguyen HS Ho L Palmer BM Wolfe (2000) ArticleTitleA comparison study of laparoscopic versus open gastric bypass for morbid obesity J Am Coll Surg 191 149–157 Occurrence Handle10.1016/S1072-7515(00)00276-3 Occurrence Handle10945358
PR Schauer S Ikramuddin W Gourash et al. (2000) ArticleTitleOutcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity Ann Surg 232 515–529 Occurrence Handle10.1097/00000658-200010000-00007 Occurrence Handle10998650
K Schneider M Greer M Neill (2004) ArticleTitleHow to lose big People 26 76–82
TL Sims MA Mullican EC Hamilton DA Provost DB Jones (2003) ArticleTitleRoutine upper gastrointestinal Gastrografin swallow after laparoscopic Roux-en-Y gastric bypass Obes Surg 13 66–72 Occurrence Handle10.1381/096089203321136610 Occurrence Handle12630616
AC Wittgrove GW Clark LJ Tremblay (1994) ArticleTitleLaparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases Obes Surg 4 353–357 Occurrence Handle10.1381/096089294765558331 Occurrence Handle10742801
AM Wolf GA Colditz (1996) ArticleTitleSocial and economic effects of body weight in the United States Am J Clin Nutr 63 466S–469S Occurrence Handle8615344
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hwang, R.F., Swartz, D.E. & Felix, E.L. Causes of small bowel obstruction after laparoscopic gastric bypass. Surg Endosc 18, 1631–1635 (2004). https://doi.org/10.1007/s00464-004-8804-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-004-8804-2