Treatment of nonadhesive bowel obstruction following gastric bypass

BACKGROUND: Bowel obstruction secondary to internal hernias following laparoscopic and open gastric bypass is well reported. The number of gastric bypasses being performed in the United States continues to increase. As many patients undergo surgery at centers geographically distant from their home, increasing numbers of patients will present to their local emergency rooms with abdominal complaints that will need to be addressed by general surgeons who are not performing bariatric surgery. METHODS: Review of a prospective database of patients operated on in a general surgery practice performing bariatric surgery. RESULTS: Over a 14-month period, 9 patients requiring operative intervention presented to our practice with nonadhesive bowel obstruction following both open and laparoscopic bariatric surgery. Causes of obstructions included cicatrical narrowing in the Roux limb at the transverse mesocolon defect (1 patient) and internal hernias through the transverse mesocolon (5 patients), Petersen's hernia (2 patients), and at the jejunojejunostomy (1 patient). Seven patients were treated laparoscopically and 2 underwent laparotomy. Our diagnostic and operative approach is described. CONCLUSIONS: Surgeons, including those not performing bariatric surgery, will be treating more patients with bowel obstruction following gastric bypass in the future. The etiology and management of bowel obstruction after gastric bypass differs from the conventional management of bowel obstruction. When surgery is required, most of these patients can be treated laparoscopically.