Original articleBlood clot obstruction of the jejunojejunostomy after laparoscopic gastric bypass
Section snippets
Methods
From June 2004 to March 2011, 1066 patients underwent laparoscopic Roux-en-Y gastric bypass at Oslo University Hospital, Aker. Four surgeons performed all the procedures. The patients were identified from a prospective database of all patients who underwent bariatric surgery at the hospital. All reoperations were evaluated for the indication and findings. The Norwegian Data Protection Agency approved and licensed the patient register. The patients provided signed approval for the use of the
Results
Of 1066 patients, 5 (.5%) with early obstruction of the JJ from a blood clot were identified (Table 1). These 5 patients included 4 women and 1 man, with a median age of 37 years (range 32–51) and median body mass index of 42 kg/m2 (range 40–46; Table 1). Patient 1 had hyperlipidemia, patient 2 hypertension and epilepsy, and patient 5 had diabetes, hyperlipidemia, coronary artery disease, hypothyroidism, and chronic nephropathy. The remaining 2 patients had no somatic co-morbidity. Patient 5
Discussion
Postoperative intraluminal bleeding can cause severe complications after gastric bypass surgery. The incidence of gastrointestinal bleeding after gastric bypass has been reported in the range of .6%–3.7% [2], [4], [5], [6]. Such bleeding is usually self-limiting and often managed by a reduction of the low-molecular-weight heparin dosage, transfusions of fresh frozen plasma and blood, or endoscopic intervention at the gastrojejunostomy. Intraluminal bleeding can occur at the gastrojejunostomy or
Conclusion
Intraluminal blood clots can cause early obstruction at the distal anastomosis after gastric bypass. Laparoscopic evacuation of the coagulated blood without revision of the JJ and gastric remnant decompression has been our preferred treatment. Awareness of this potentially rapidly progressive and life-threatening complication can allow immediate intervention and might thus reduce the risk of serious sequelae.
Disclosures
The authors have received sponsored participation to international congresses of surgery by different companies not involved in the present study.
References (15)
- et al.
Gastrointestinal bleeding after gastric bypass surgery: nuisance or catastrophe?
Surg Obes Relat Dis
(2010) - et al.
Acute, complete proximal small bowel obstruction after laparoscopic gastric bypass due to intraluminal blood clot formation
Surg Obes Relat Dis
(2005) - et al.
Hospital complication rates with bariatric surgery in Michigan
JAMA
(2010) - et al.
Complications after laparoscopic gastric bypass—a review of 3464 cases
Arch Surg
(2003) - et al.
Mortality after bariatric surgery—analysis of 13,871 morbidly obese patients from a national registry
Ann Surg
(2007) - et al.
Establishing laparoscopic Roux-en-Y gastric bypass: perioperative outcome and characteristics of the learning curve
Obes Surg
(2009) - et al.
Complications of antiobesity surgery
Nat Clin Pract Gastroenterol Hepatol
(2007)
Cited by (13)
Surgical management of obstructing clot at the jejunojejunostomy after gastric bypass: a single center experience and literature review
2021, Surgery for Obesity and Related DiseasesCitation Excerpt :We were not able to associate the infections with preoperative co-morbidities such as diabetes or chronic proton pump inhibitor use. In a similar series of 5 patients, Mala et al. describe a protracted length of stay with morbidities of abdominal wall abscesses and fluid collections requiring IR drainage [14]. In his series he describes placing a G-tube in the remnant stomach of the patients but does not describe whether this was done before the clot was removed, the technique that we advise.
Endoscopic management of postoperative bleeding
2023, Clinical EndoscopyManagement of gastrointestinal bleeding following bariatric surgery
2022, Mini-invasive SurgeryThe Jejunojejunostomy: an Achilles Heel of the Roux-en-Y Gastric Bypass Construction
2021, Obesity SurgerySmall Bowel Obstruction After Laparoscopic Roux-en-Y Gastric Bypass Caused by Hemobezoar: A Case Series and Review of Literature
2021, Surgical Laparoscopy, Endoscopy and Percutaneous Techniques