Surgical Endoscopy

, Volume 21, Issue 11, pp 1914–1918 | Cite as

A complication of Roux-en-Y gastric bypass: intestinal obstruction

  • T. RogulaEmail author
  • P. R. Yenumula
  • P. R. Schauer



Intestinal obstruction is a significant and increasingly recognized complication after laparoscopic and open gastric bypass.

Materials and methods

The medical records of 3,463 patients who had gastric bypass during the study period from July 1997 to December 2004 at a single bariatric center were evaluated. 1,120 patients had retrocolic, retrogastric Roux limb placement and 2,343 patients had antecolic, antegastric.


40 patients had 44 intestinal obstructions (1.27%). The onset ranged from 1 day to 7 years postoperatively (mean 16.9 months). Internal hernia at the transverse mesocolon defect was the most common cause. 36 (3.2%) obstructions were observed in retrocolic, retrogastric vs. 8 (0.3%) in antecolic, antegastric approach. Internal hernia repair at mesocolinic effect (n = 11), jejunojejunostomy mesenteric defect repair (n = 7), lysis of adhesions (n = 16) were the most common procedures. A total of 70.5% were done laparoscopically.


A high index of suspicion is needed to diagnose bowel obstruction after gastric bypass. Radiological imaging of the abdomen has significant limitations. Surgical exploration should be performed without delay. Diagnostic laparoscopy is a safe and effective therapy. We recommend closing all mesenteric defects to prevent internal hernias. The antecolic, antegastric technique reduces the incidence of internal hernias.


Obesity Bariatric surgery Small bowel obstruction  Internal hernia 


  1. 1.
    Champion JK, Williams M (2003) Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg 13:596–600PubMedCrossRefGoogle Scholar
  2. 2.
    Felsher J, Brodsky J, Brody F (2003) Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Surgery 134:501–505PubMedCrossRefGoogle Scholar
  3. 3.
    Higa KD, Ho T, Boone KB (2003) Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment, and prevention. Obes Surg 13:350–354PubMedCrossRefGoogle Scholar
  4. 4.
    Schauer P, Ikramuddin S, Hamad G, Gourash W (2003) The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc 17:212–215PubMedCrossRefGoogle Scholar
  5. 5.
    Podnos YD, Jimenez JC, Wilson SE, Stevens CM, Nguyen NT (2003) Complications after laparoscopic gastric bypass: a review of 3,464 cases. Arch Surg 138:957–961PubMedCrossRefGoogle Scholar
  6. 6.
    Brolin RE, Kenler HA, Gorman JH, Cody RP (1992) Long-limb gastric bypass in the superobese: a prospective randomized study. Ann Surg 215:387–395PubMedCrossRefGoogle Scholar
  7. 7.
    Bocker J, Vasile J, Zager J, Goodman E (2004) Intussusception: an uncommon cause of postoperative small bowel obstruction after gastric bypass [see comment]. Obes Surg 14:116–119PubMedCrossRefGoogle Scholar
  8. 8.
    Majeski J, Fried D (2004) Retrograde intussusception after Roux-en-Y gastric bypass surgery. J Am Coll Surg 199:988–989PubMedCrossRefGoogle Scholar
  9. 9.
    Duane TM, Wohlgemuth S, Ruffin K (2000) Intussusception after Roux-en-Y gastric bypass. Am Surg 66:82–84PubMedCrossRefGoogle Scholar
  10. 10.
    Karlstrom L, Kelly KA (1989) Ectopic jejunal pacemakers and gastric emptying after Roux gastrectomy: effect of intestinal pacing. Surgery 106:867–871PubMedGoogle Scholar
  11. 11.
    Awais O, Raftopoulos I, Luketich JD, Courcoulas A (2005) Acute, complete proximal small bowel obstruction after laparoscopic gastric bypass due to intraluminal blood clot formation. Surg Obes Related Dis 1:418–422, discussion 422–423CrossRefGoogle Scholar
  12. 12.
    Charles A, Domingo S, Goldfadden A, Fader J, Lampmann R, Mazzeo R (2005) Small bowel ischemia after Roux-en-Y gastric bypass complicated by pregnancy: a case report. Am Surg 71:231–234PubMedGoogle Scholar
  13. 13.
    Kakarla N, Dailey C, Marino T, Shikora SA, Chelmow D (2005) Pregnancy after gastric bypass surgery and internal hernia formation. Obstet Gynecol 105(5 Pt 2):1195–1198PubMedGoogle Scholar
  14. 14.
    Loar PV III, Sanchez-Ramos L, Kaunitz AM, Kerwin AJ, Diaz J (2005) Maternal death caused by midgut volvulus after bariatric surgery. Am J Obstet Gynecol 193:1748–1749PubMedCrossRefGoogle Scholar
  15. 15.
    Schweitzer MA, DeMaria EJ, Broderick TJ, Sugerman HJ (2000) Laparoscopic closure of mesenteric defects after Roux-en-Y gastric bypass. J Laparoendosc Adv Surg Tech Part A 10:173–175CrossRefGoogle Scholar
  16. 16.
    Brolin RE (1995) The antiobstruction stitch in stapled Roux-en-Y enteroenterostomy. Am J Surg 169:355–357PubMedCrossRefGoogle Scholar
  17. 17.
    Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J (2000) Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232:515–529PubMedCrossRefGoogle Scholar
  18. 18.
    Taylor JD, Leitman IM, Rosser JB, Davis B, Goodman E (2006) Does the position of the alimentary limb in Roux-en-Y gastric bypass surgery make a difference? J Gastrointest Surg 10:1397–1399PubMedCrossRefGoogle Scholar
  19. 19.
    Eid GM, Collins J (2005) Application of a trocar wound closure system designed for laparoscopic procedures in morbidly obese patients. Obes Surg 15:871–873PubMedCrossRefGoogle Scholar
  20. 20.
    Blachar A, Federle MP (2002) Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery in patients who are morbidly obese: findings on radiography and CT. AJR Am J Roentgenol 179:1437–1442PubMedGoogle Scholar
  21. 21.
    Blachar A, Federle MP, Brancatelli G, Peterson MS, Oliver JH, Li W (2001) Radiologist performance in the diagnosis of internal hernia by using specific CT findings with emphasis on transmesenteric hernia. Radiology 221:422–428PubMedCrossRefGoogle Scholar
  22. 22.
    Lockhart M, Tessler FN, Canon CL, Smith J Kevin, Larrison MC, Fineberg NS, Roy BP, Clements RH (2007) Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. AJR Am J Roentgenol 188:745–750PubMedCrossRefGoogle Scholar
  23. 23.
    Higa KD, Boone KB, Ho T (2000) Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients—what have we learned? Obes Surg 10:509–513PubMedCrossRefGoogle Scholar
  24. 24.
    Garza E Jr, Kuhn J, Arnold D, Nicholson W, Reddy S, McCarty T (2004) Internal hernias after laparoscopic Roux-en-Y gastric bypass. Am J Surg 188:796–800PubMedCrossRefGoogle Scholar
  25. 25.
    Szomstein S, Kaidar-Person O, Naberezny K, Cruz-Correa M, Rosenthal R (2006) Correlation of radiographic and endoscopic evaluation of gastrojejunal anastomosis after Roux-en-Y gastric bypass. Surg Obes Related Dis 2:617–621CrossRefGoogle Scholar
  26. 26.
    Nguyen NT, Stevens CM, Wolfe BM (2003) Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass. J Gastrointest Surg 7:997–1003, discussion 1003PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Bariatric and Metabolic InstituteCleveland Clinic FoundationClevelandUSA
  2. 2.Michigan State UniversityLansingUSA

Personalised recommendations