Small Bowel Obstruction and Internal Hernias after Laparoscopic Roux-en-Y Gastric Bypass |
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Authors: | J Ken Champion Michael Williams |
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Institution: | (1) Videoscopic Institute of Atlanta, Atlanta, GA, USA;(2) Videoscopic Institute of Atlanta, Atlanta, GA, USA |
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Abstract: | 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. |
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Keywords: | MORBID OBESITY BARIATRIC SURGERY LAPAROSCOPIC GASTRIC BYPASS TECHNIQUE SMALL BOWEL OBSTRUCTION |
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