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1.
Abasbassi M Pottel H Deylgat B Vansteenkiste F Van Rooy F Devriendt D D'Hondt M 《Obesity surgery》2011,21(12):1822-1827
Reported incidence of small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass varies between 1.5% and 3.5%.
It has been suggested that the antecolic antegastric laparoscopic Roux-en-Y gastric bypass (AA-LRYGB) is associated with a
low incidence of internal herniation (IH). Therefore we routinely did not close mesenteric defects. The records of 652 consecutive
patients undergoing primary AA-LRYGB from January 2003 to December 2009 in a single institution were retrospectively reviewed
to determine the incidence, etiology, clinical symptoms, radiologic diagnostic accuracy and operative outcomes of SBO. Of
the 652 patients, 63 (9.6%) developed SBO. The majority (6.9%, 45 patients) had a SBO due to IH. In 41 (91%) cases, the IH
was at the jejunojejunostomy (JJ), four cases had an IH at Petersen’s space. Adhesions and ventral hernia were found in 14
(2.1%) and four (0.6%) cases, respectively. Twenty-nine out of 63 cases had negative computed tomography (CT) findings and
IH was diagnosed on CT in only 33% (14/45) of patients with IH. All patients underwent diagnostic laparoscopy. No bowel resections
had to be performed. In contrast to previous reports, a high incidence of SBO with a high rate of IH at the JJ site was found
in our series. Accuracy of CT is low and diagnostic laparoscopy is mandatory when SBO is suspected. Since 2010 we have started
closing the JJ site, and data on SBO are collected prospectively. We believe that closing of the mesenteric defects is a mandatory
step, even in an AA-LRYGB. 相似文献
2.
Valerie A. Marks Josefina Farra Francisco Jacome Nestor de la Cruz-Muñoz 《Surgery for obesity and related diseases》2013,9(5):736-742
BackgroundSmall bowel anastomoses can present a technical challenge during laparoscopic procedures, particularly gastric bypass procedures. Early small bowel obstruction (SBO) rates associated with such procedures occur in .7%–5.2% of patients. Herein, we describe how a bidirectional stapling technique moves the enterotomy to the center of the anastomosis, decreasing the chances of an afferent limb obstruction.MethodsA prospectively collected cohort of 2263 consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass with bidirectional stapling of the small bowel anastomosis was evaluated for early SBO. All patients met the National Institutes of Health criteria for bariatric surgery.ResultsOverall, 3 patients’ perioperative courses were complicated by perioperative, early SBO (.13%). These instances were all attributable to intraluminal blood clots and not from inadvertent narrowing of the afferent limb. One was diagnosed on postoperative day 1 by upper gastrointestinal study (UGI); 2 were diagnosed on postoperative day 2 by computed tomography (CT) scan with oral contrast. All 3 patients’ complications were managed with a laparoscopic operation.ConclusionThe bidirectional stapling technique for small bowel anastomoses, with our modifications, is a rapid, well-tolerated, and effective technique that offers potential advantages over standard laparoscopic anastomotic techniques by reducing perioperative SBO complications. 相似文献
3.
BackgroundAlthough it is generally accepted that closure of mesenteric defects after laparoscopic Roux-en-Y gastric bypass (LRYGB) reduces the incidence of small bowel obstruction (SBO), data supporting this belief are inconsistent. After a spike in acute SBO cases in our LRYGB patients, we changed our technique of mesenteric closure. The objective of this study was to determine whether modification of our technique of mesenteric closure would decrease the incidence of SBO and internal hernia after LRYGB.MethodsThe records of 872 consecutive patients who had antecolic LRYGB by 1 surgeon over a 9-year interval were reviewed for acute SBO. The first 654 patients, mean follow up = 100±12 months, had incomplete mesenteric closure versus complete closure in 218 remaining patients, mean follow up = 40±14 months. Minimum follow up was 1 year.ResultsTotal incidence of acute SBO was 4.0% (35/872), including 4.4% (29/654) in the incomplete closure group versus 2.8% (6/218) in the complete closure patients. Seventeen (2.6%) of the incomplete closure patients with acute SBO had internal hernias versus 1 (.5%) in the complete closure group. Twenty-six patients with incomplete closure developed symptoms of SBO and subsequently had elective repair of mesenteric hernias versus none in complete closure group (P<.02). Postoperative morbidity and mortality rates after surgery for SBO were 30% and 7.4% in incomplete group versus zero in patients with complete closure.ConclusionComplete closure of mesenteric defects in antecolic LRYGB resulted in a significant reduction in internal mesenteric hernias. Complications were also reduced after operations for SBO in patients who had complete mesenteric closure. 相似文献
4.
《Surgery for obesity and related diseases》2008,4(5):587-593
BackgroundPatients who have undergone laparoscopic gastric bypass have a high risk of developing an internal hernia. Most patients present 9–18 months postoperatively with a weight loss of 75–120 lb and pain out of proportion to the physical findings. Given the risks of internal hernias and the difficulty in radiologic diagnosis, we have developed a single algorithm to avoid the triage complication of a “missed” diagnosis.MethodsA retrospective review was performed of 1500 bariatric procedures performed from 2001 to 2006, 33% (laparoscopic Roux-en-Y gastric bypass) of which were performed using an antecolic antegastric Roux limb, with all potential defects, including Peterson's, closed. Of these 1500 patients, 75 were evaluated for abdominal pain to rule out an internal hernia.ResultsOf the 75 patients, 40 had signs of an internal hernia or abdominal obstruction on computed tomography and underwent laparoscopy. The operative time was 38–45 minutes, and the length of stay was 1.5 days. The remaining 35 patient's computed tomography scans were interpreted as “no evidence” of internal hernia or obstruction. Of the 35 patients, 29 underwent diagnostic laparoscopy and had either an internal hernia or critical adhesions. Thus, 69 patients (92%) underwent diagnostic laparoscopy. In 6 patients, the symptoms resolved completely without any surgical intervention.ConclusionAt our institution, patients who undergo laparoscopic Roux-en-Y gastric bypass with a weight loss of 75–120 lb undergo computed tomography with contrast to rule out other potential nonoperative causes. Also, unless clinically stable or the patient has complete resolution of their pain, they then undergo laparoscopy for evaluation. 相似文献
5.
Hideharu Shimizu Munique Maia Matthew Kroh Philip R. Schauer Stacy A. Brethauer 《Surgery for obesity and related diseases》2013,9(5):718-724
BackgroundLimited data are available regarding early postoperative small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass (LRYGB). The aim of the present study was to review our experience with early SBO after LRYGB. The setting was a tertiary referral bariatric center.MethodsWe reviewed a prospectively maintained database to assess the diagnosis, management, and outcomes of patients who underwent surgery for SBO within 30 days of LRYGB.ResultsFrom April 2004 to December 2011, 2126 patients underwent LRYGB. Of these patients, 11 (.5%) required surgical management for early SBO. Of the 11 patients, 9 were women and 2 were men. with a mean age of 53 years (range 35–70) and mean body mass index of 45 kg/m2 (range 38–65). The average interval from LRYGB to the presentation of SBO was 5.0 days (range 2–15). All early SBOs were diagnosed by computed tomography with oral contrast. The causes of early SBO included kinking at the jejunojejunostomy in 4, an intraluminal blood clot near the jejunojejunostomy in 2, angulation of the Roux limb in 1, mesenteric hematoma in 1, intra-abdominal hematoma in 1, obstruction of common channel in 1, and pelvic adhesions from previous surgery in 1. Diagnostic laparoscopy was attempted in all patients. Four patients required conversion to open surgery. Postoperative complications developed in 5 patients; no patient died. Laparoscopic management of early SBO resulted in fewer complications than the open approach.ConclusionEarly SBO after LRYGB is uncommon; however, a prompt diagnosis and surgical intervention are important to prevent additional morbidity. The ability to complete the reoperation laparoscopically varies with the etiology and location of the obstruction. 相似文献
6.
Arturo Rodríguez Maureen Mosti Mauricio Sierra Rocío Pérez-Johnson Salvador Flores Guillermo Dominguez Hugo Sánchez Artemio Zarco Karen Romay Miguel F. Herrera 《Obesity surgery》2010,20(10):1380-1384
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. 相似文献7.
Small Bowel Obstruction and Internal Hernias after Laparoscopic Roux-en-Y Gastric Bypass 总被引:10,自引:7,他引:3
Background: Small bowel obstruction (SBO) is a recognized complication of open bariatric surgery; however, the incidence after
laparoscopic procedures is not clearly established. This paper reviews our experience with small bowel obstruction after laparoscopic
Roux-en-Y gastric bypass. Methods: Between 1995 and 2001, 711 (246 antecolic, 465 retrocolic) patients underwent a laparoscopic
proximal divided Roux-en-Y gastric bypass via the linear endostapler technique. 13 patients (1.8%) developed SBO requiring
surgical intervention.There were 11 females and 2 males, ages 29-60 (mean 38), with mean weight 126 kg (range 105-188), and
mean BMI 50 (range 41-59). 7 obstructive patients (55%) had undergone previous open abdominal surgery. Median time to obstruction
was 21 days (range 5-1095). Mean follow-up of all patients is 43 months (range 3-79). Results: Etiology of obstruction was
internal hernia - 6, adhesive bands - 5 (only 2 were related to prior open surgery), mesocolon window scarring - 1, and incarcerated
ventral hernia - 1. The incidence of SBO was 4.5% (11/246) in the retrocolic group, and 0.43% (2/465) in the antecolic group,
which was highly significant (P=.006). 1 adhesive patient required an open bowel resection for ischemia. There was 1 death. Conclusion: SBO occurred with
an overall incidence of 1.8% in a large series of laparoscopic gastric bypass patients, and was associated with a high morbidity.
A significant decrease in occurrence was found after adoption of antecolic placement of the Roux limb. 相似文献
8.
Cho M Carrodeguas L Pinto D Lascano C Soto F Whipple O Gordon R Simpfendorfer C Gonzalvo JP Szomstein S Rosenthal RJ 《Journal of the American College of Surgeons》2006,202(2):262-268
BACKGROUND: The resultant derangement of the normal gastrointestinal anatomy after a gastric bypass procedure increases the incidence of, and level of difficulty diagnosing, partial small bowel obstruction (SBO) in morbidly obese patients. We evaluated the diagnostic methods for partial SBO and the clinical characteristics according to the time after initial operation. STUDY DESIGN: Data of 1,400 consecutive patients who underwent antecolic antegastric laparoscopic Roux-en-Y gastric bypass between 2001 and 2004 were retrospectively analyzed. RESULTS: Partial SBO developed in 21 (1.5%) patients after laparoscopic Roux-en-Y gastric bypass. Five of 15 patients were preoperatively diagnosed with SBO by a gastrograffin study and CT scan diagnosed 17 of 19 patients (p = 0.002). Causes of SBO included jejunojejunostomy stenosis (n = 6), adhesions (n = 5), incarcerated ventral hernia (n = 5), internal hernia (n = 3), and other (n = 2). The majority of patients (n = 19) underwent surgical treatment. CONCLUSIONS: The most frequent cause of early SBO is jejunojejunal anastomotic stenosis. CT scan is a more accurate diagnostic tool for detecting partial SBO, compared with use of a gastrograffin study. Operation remains the most appropriate and definitive treatment for this complication and the laparoscopic approach is a feasible and safe surgical treatment option. 相似文献
9.
Introduction: Small bowel obstruction (SBO) is a well-known complication of laparoscopic Roux-en-Y gastric bypass (LRYGBP).
We describe 7 cases of jejunojejunal anastomotic obstruction related to adhesion formation after closure of the mesenteric
"leaves" defect with non-absorbable suture. Methods: All patients undergoing LRYGBP from October 2002 until February 2005
were entered into a prospective, longitudinal database. All patients who subsequently presented with SBO were analyzed. Results:
Jejunojejunal anastomotic obstruction occurred in 7 out of 152 patients (4.6%) in whom LRYGBP was performed from October 2002
to February 2004. Since February 2004, the suture used to close the jejunojejunal mesenteric leaves defect was changed from
non-absorbable Dacron (Surgidac™) to absorbable suture material. The mean interval between initial LRYGBP and subsequent SBO was 153 days. Operative findings
common to all 7 cases were dilated loops of proximal small bowel, and a single adhesion just distal to the Roux-Y anastomosis.
Following adhesiolysis, each patient had prompt return of bowel function without recurrence of obstruction. Of the 156 patients
who have since undergone LRYGBP, none have presented with SBO, and this difference is statistically significant (P=0.008). Conclusions: The overall rate of SBO (2.3%) is consistent with the previous literature, although the incidence of
adhesions specifically at the jejunojejunal anastomosis is higher than that previously encountered. It appears that the incidence
of postoperative SBO at the jejunojejunal anastomosis is directly linked to the choice of suture material intraoperatively.
As such, absorbable suture should be used to close the jejunojejunal mesenteric leaves defect. 相似文献
10.
Ahmed R. Ahmed Gretchen Rickards Susan Messing Syed Husain Joseph Johnson Thad Boss William O'Malley 《Surgery for obesity and related diseases》2009,5(2):194-198
BackgroundPartial small bowel obstruction can occur as a result of circumferential extrinsic compression of the Roux limb as it traverses the transverse mesocolic rent from thickened cicatrix formation in this area. The aim of this study is to examine the incidence of Roux limb compression with particular attention to the timing of presentation and associated weight loss in the setting of a university hospital in the United States.MethodsA retrospective chart review was performed of all patients undergoing laparoscopic Roux-en-Y gastric bypass who developed symptomatic small bowel obstruction requiring operative intervention from January 1, 2000 and September 15, 2006.ResultsOf 2215 patients, 20 (.9%) developed symptomatic Roux limb compression. The mean time to presentation was 48 days after LRYGB. By this stage, the mean percentage of excess body weight loss was 29%. Of the 20 patients, 19 underwent an upper gastrointestinal contrast study, the results of which confirmed the diagnosis. In all cases, laparoscopic intervention was successful in freeing the constricted Roux limb by dividing the cicatrix formation between the Roux limb and mesocolic window. Switching from continuous to interrupted closure of the space between Roux limb and mesocolic window appeared to reduce the incidence of this complication (P <.05).ConclusionNarrowing at the transverse mesocolon rent is an uncommon cause of small bowel obstruction after retrocolic laparoscopic Roux-en-Y gastric bypass. Unlike internal hernias, which tend to occur later in the clinical course and are associated with significant weight loss, Roux limb obstruction occurs earlier after gastric bypass and is not associated with significant weight loss. Interrupted closure of the mesocolic window might reduce the risk of Roux compression. 相似文献
11.
Suzuki K Umehara Y Kimura T 《Surgical laparoscopy, endoscopy & percutaneous techniques》2003,13(4):254-256
We performed elective laparoscopic adhesiolysis in 21 patients with small bowel obstruction. The procedure was completely laparoscopic or laparoscopy assisted in 17 patients, but 4 patients required full laparotomy due to internal hernia in 2, perforation of the small bowel associated with dense adhesions in 1, and carcinoma of the cecum in 1. In patients with a laparoscopic or laparoscopy-assisted procedure, the mean operating time, mean time until the return of bowel function, and mean postoperative stay were 94 minutes, 3.3 days, and 9.9 days, respectively. During follow-up for 14 to 44 months, 3 patients developed recurrent obstruction, 1 patient suffered from catheter-induced thrombosis, and 1 patient died from lung cancer. Elective laparoscopy can be performed safely and effectively in selected patients with intermittent small bowel obstruction. 相似文献
12.
Bowel obstruction after open and laparoscopic gastric bypass surgery for morbid obesity 总被引:3,自引:0,他引:3
BACKGROUND: Bowel obstruction is increasingly recognized as an important complication after gastric bypass. This study analyzed late bowel obstruction after open and laparoscopic gastric bypass surgery. STUDY DESIGN: The medical records of 1,378 patients who had proximal gastric bypass during the years 2002 and 2003 at a large bariatric center were evaluated for readmission with bowel obstruction requiring operations. In the study group, 697 patients underwent a laparoscopic approach and 735 had an open approach to gastric bypass. Patients had a minimum followup of 18 months. RESULTS: In the laparoscopic group, 68 of the 697 patients were readmitted for bowel obstruction requiring operations, for an incidence of 9.7%. There were 14 additional recurrent obstructions, for a total of 82 operations. Of the 68 patients requiring reoperations, 3 (4.4%) required bowel resection and 8 (11.7%) had conversion to an open approach. Bowel resections were performed in two of the three patients with a second episode of bowel obstruction. The average time intervals between the primary operation in 2002 and 2003 and the first episode of obstruction were 511 and 385 days, respectively. There were no readmissions requiring operations for late bowel obstruction in the open gastric bypass group. CONCLUSIONS: We found an unanticipated high incidence of bowel obstruction after laparoscopic gastric bypass surgery. There were no hospital admissions for bowel obstruction requiring operations in the open gastric bypass group. Lack of adhesions and the resulting free displacement of small bowel after laparoscopy appear to be the cause of this complication. Open gastric bypass surgery produces thin, diffuse upper abdominal adhesions that may then stabilize the bowel and prevent internal hernias and bowel obstruction. An open approach may be a reasonable option for management of recurrent episodes of bowel obstruction after laparoscopy. 相似文献
13.
P. Strickland D. J. Lourie E. A. Suddleson J. B. Blitz S. C. Stain 《Surgical endoscopy》1999,13(7):695-698
Background: Acute small bowel obstruction (SBO) has been a relative contraindication for laparoscopic treatment due to the potential
for bowel distention and the risk of enteric injury. However, as laparoscopic experience has increased, surgeons have begun
to apply minimal access techniques to the management of acute SBO.
Methods: A retrospective review was performed of all patients with acute SBO in whom laparoscopic treatment was attempted. Patients
with chronic symptoms and elective admission were excluded. Patients treated by laparoscopy were compared to those converted
to laparotomy for differences in morbidity, postoperative length of stay, and return of bowel function as evidenced by toleration
of a liquid diet.
Results: Laparoscopy was performed in 40 patients for acute SBO. The etiologies of obstruction included adhesions (35 cases), Meckel's
diverticulum (two cases), femoral hernia (one case), periappendiceal abscess (one case), and regional enteritis (one case).
Laparoscopic treatment was possible in 24 patients (60%), but 13 patients required conversion to laparotomy for inadequate
laparoscopic visualization (two cases), infarcted bowel (two cases), enterotomy (four cases), and inability to relieve the
obstruction laparoscopically (five cases). There were ten complications—one in the laparoscopic group (pneumonia) and nine
in the converted group (prolonged ileus, four cases; wound infection, two cases; pneumonia, two cases; and perioperative myocardial
infarction, one case). Respectively, the laparoscopic and converted groups had mean operative times of 68 and 106 min a mean
return of bowel function of 1.8 and 6.2 days, and a mean postoperative stay of 3.6 and 10.5 days. Long-term follow-up was
available in 34 patients. One recurrence of SBO requiring operation occurred in each group during a mean follow-up of 88 weeks.
Conclusions: Laparoscopy is a safe and effective procedure for the treatment of acute SBO in selected patients. This approach requires
surgeons to have a low threshold for conversion to laparotomy. Laparoscopic treatment appears to result in an earlier return
of bowel function and a shorter postoperative length of stay, and it will likely have lower costs.
Received: 31 March 1998/Accepted: 25 August 1998 相似文献
14.
Introduction and importanceThe literature described Candy cane syndrome (CCS) as causing various symptoms and affecting patients' quality of life. Most of the literature described this syndrome occurrence at gastrojejunostomy (GJ) anastomosis. The literature lacks data on this syndrome occurring at the jejunojejunostomy (JJ).Case presentationWe describe a patient who underwent revision of laparoscopic gastric bypass (LGB) due to weight regain and presented three days after the procedure with small bowel obstruction (SBO). The patient was admitted as she demonstrated a picture of SBO. A complete workup and contrast study was done and showed dilated bowel loops. The patient was taken for exploratory laparoscopy, which revealed dilated 10–15 cm candy cane near the JJ, causing and obstruction. Resection of the elongated blind pouch was done, and the patient tolerated the surgery with improvement in her symptoms. Preoperative imaging, perioperative management, procedure videos, and follow-up were used to describe the case.Clinical discussionAfter reviewing the literature, eight papers reported CCS, 7 of those articles mentioned the syndrome located at the GJ. CCS located near the JJ can lead to symptoms including SBO. Management is mainly surgical, and prevention of occurrence can be achieved by limiting unnecessary elongated blind pouches.ConclusionCCS is a well-established condition occurring at the GJ following LGB, but it can manifest similarly if an elongated blind limb is left unresected at the JJ. 相似文献
15.
Torres-Villalobos GM Kellogg TA Leslie DB Antanavicius G Andrade RS Slusarek B Prosen TL Ikramuddin S 《Obesity surgery》2009,19(7):944-950
Small bowel obstruction (SBO) is a recognized complication of Roux-en-Y gastric bypass (RYGB) surgery. Internal hernia (IH)
a potential problem associated with RYGB, can have severe consequences if not diagnosed. We present two cases of SBO due to
IH during pregnancy after laparoscopic RYGB (LRYGB). Both patients underwent an antecolic, antegastric LRYGB. In both patients
a Petersen’s type IH was found. We reviewed the cases reported in the literature of SBO during pregnancy after RYGB. IH should
always be ruled out in pregnant patients with previous RYGB and abdominal pain. Prompt surgical intervention is mandatory
for a good outcome. 相似文献
16.
Omar Awais Ioannis Raftopoulos James D Luketich Anita Courcoulas 《Surgery for obesity and related diseases》2005,1(4):418-22; discussion 422-3
BACKGROUND: To report the presentation and management of early complete proximal small bowel obstruction from intraluminal clot after laparoscopic Roux-en-Y gastric bypass. METHODS: We performed a retrospective chart review of 5 female patients who developed small bowel obstruction at the jejunojejunostomy (JJ) secondary to intraluminal clot from January 2001 to January 2003. We analyzed the signs and symptoms, etiology of bowel obstruction, and operative treatment. RESULTS: From January 2001 to January 2003, 5 patients who had undergone successful laparoscopic Roux-en-Y gastric bypass developed proximal small bowel obstruction from a solid intraluminal clot secondary to staple line bleeding. All patients were women, with an average age and body mass index of 37 years and 43.41 kg/m(2), respectively. All patients underwent an upper gastrointestinal series on postoperative day 1, which revealed no leak, and all became symptomatic on postoperative day 2. Tachycardia and a "sense of impending doom" were both observed in 80% of the patients with this clinical syndrome. The intraoperative findings consistently revealed intraluminal clot obstructing the JJ. After reexploration and anastomotic revision, all patients had an uneventful recovery, with an average hospital length of stay of 9.8 days (range 8-11). CONCLUSION: Staple line bleeding potentially exacerbated by perioperative subcutaneous heparin use can cause proximal small bowel obstruction at the JJ after laparoscopic Roux-en-Y gastric bypass. It presents on postoperative day 2 most commonly as tachycardia and a "sense of impending doom." Prompt recognition and immediate reexploration will lead to an uneventful recovery. The need for complete anastomotic JJ revision is discussed. 相似文献
17.
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 jejunojej-unostomy.
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 cause 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.
Online publication: 13 October 2004 相似文献
18.
Background: Roux-en-Y gastric bypass (RYGBP) has long been associated with the possible development of internal hernias, with
a reported incidence of 1-5%. Because it induces fewer adhesions than laparotomy, the laparoscopic approach to this operation
appears to increase the rate of this complication, which can present dramatically. Methods: Data from all patients undergoing
bariatric surgery are introduced prospectively in a data-base. Patients who were reoperated for symptoms or signs suggestive
of an internal hernia were reviewed retrospectively, with special emphasis on clinical and radiological findings, and surgical
management. Results: Of 607 patients who underwent laparoscopic primary or reoperative RYGBP in our two hospitals between
June 1999 and January 2006, 25 developed symptoms suggestive of an internal hernia, 2 in the immediate postoperative period,
and 23 later on, after a mean of 29 months and a mean loss of 14.5 BMI units. 9 of the latter presented with an acute bowel
obstruction, of which 1 required small bowel resection for necrosis. Recurrent colicky abdominal pain was the leading symptom
in the others. Reoperation confirmed the diagnosis of internal hernia in all but 1 patient. The most common location was the
meso-jejunal mesenteric window (16 patients, 56%), followed by Petersen's window (8 patients, 27%), and the mesocolic window
(5 patients, (17%). Patients in whom the mesenteric windows had been closed using running non-absorbable sutures had fewer
hernias than patients treated with absorbable sutures at the primary procedure (1.3% versus 5.6%, P=0.03). Except in the acute setting, clinical and radiological findings were of little help in the diagnosis. Conclusions:
Except in the setting of acute obstruction, clinical and radiological findings usually do not help in the diagnosis of internal
hernia. A high index of suspicion, based mainly on the clinical history of recurrent colicky abdominal pain, is the only means
to reduce the number of acute complications leading to bowel resection by offering the patient an elective laparoscopic exploration
with repair of all the defects. Prevention by carefully closing all potential mesenteric defects with running non-absorbable
sutures during laparoscopic RYGBP, which we consider mandatory, seems appropriate in reducing the incidence of this complication. 相似文献
19.
Internal hernias are a specific cause of acute abdominal pain and are a well-known complication after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Although internal hernias are a rare cause of intestinal obstruction, they may evolve towards serious complications, such as extensive bowel ischemia and gangrene, with the need for bowel resection and sometimes for a challenging reconstruction of intestinal continuity. The antecolic position of the Roux limb is associated with a decrease in the incidence of small-bowel obstruction and internal hernias. The best prevention of the formation of these hernias is probably by closure of potential mesenteric defects at the initial operation with a non-absorbable running suture. We present a patient in late pregnancy with a small-bowel volvulus following laparoscopic Roux-en-Y gastric bypass for morbid obesity and discuss the available literature. For a favorable obstetric and neonatal outcome, it is crucial not to delay surgical exploration and an emergency operation usually is mandatory. 相似文献
20.
Bonouvrie Daniëlle S. van Beek Hermen C. Taverne Sophie B. M. Janssen Loes van der Linden Toine N. van Dielen François M. H. Greve Jan W. M. Leclercq Wouter K. G. 《Obesity surgery》2022,32(2):245-255
Obesity Surgery - Small bowel obstruction (SBO) is a late complication of Roux-en-Y gastric bypass (RYGB). In non-pregnant patients, computed tomography (CT) is the first choice of imaging. During... 相似文献