Late Perforation of the Jejuno-Jejunal Anastomosis after Laparoscopic Roux-en-Y Gastric Bypass |
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Authors: | David Goitein Pavlos K Papasavas Daniel J Gagné Philip F Caushaj |
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Institution: | (1) Temple University School of Medicine Clinical Campus at The Western Pennsylvania Hospital, Pittsburgh, PA, USA;(2) Temple University School of Medicine Clinical Campus at The Western Pennsylvania Hospital, Pittsburgh, PA, USA;(3) Temple University School of Medicine Clinical Campus at The Western Pennsylvania Hospital, Pittsburgh, PA, USA;(4) Temple University School of Medicine Clinical Campus at The Western Pennsylvania Hospital, Pittsburgh, PA, USA |
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Abstract: | Roux-en-Y gastric bypass (RYGBP) is the most commonly performed operation for the treatment of morbid obesity in the USA.
Complications related to the jejuno-jejunal (J-J) anastomosis include postoperative leak, staple-line bleeding and obstruction.
We present 3 cases of perforation at the J-J anastomosis occurring more than 30 days after surgery. 3 morbidly obese patients
underwent laparoscopic RYGBP. The side-to-side J-J anastomosis was created with a linear stapler, and the anastomotic defect
was closed with a running absorbable suture. All 3 patients had uneventful recoveries, but presented 7 to 8 weeks postoperatively
with acute abdominal pain and peritoneal signs. Exploratory laparoscopy in these patients revealed a perforation at the J-J
anastomosis. No apparent reason for the perforation was found in 2 patients. These perforations were repaired laparoscopically
with absorbable suture. The third patient had an obstruction at the J-J anastomosis from an phytobezoar and required conversion
to open technique due to limited pneumoperitoneum. All 3 patients recovered uneventfully. Late perforation of the J-J anastomosis
is a very rare complication. Primary laparoscopic repair is a feasible and safe choice of treatment. |
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Keywords: | ROUX-EN-Y GASTRIC BYPASS LAPAROSCOPIC COMPLICATIONS |
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