Advertisement

Obesity Surgery

, Volume 27, Issue 8, pp 1924–1928 | Cite as

The Utility of Diagnostic Laparoscopy in Post-Bariatric Surgery Patients with Chronic Abdominal Pain of Unknown Etiology

  • Mohammad Alsulaimy
  • Suriya Punchai
  • Fouzeyah A. Ali
  • Matthew Kroh
  • Philip R. Schauer
  • Stacy A. Brethauer
  • Ali AminianEmail author
Original Contributions

Abstract

Purpose

Chronic abdominal pain after bariatric surgery is associated with diagnostic and therapeutic challenges. The aim of this study was to evaluate the yield of laparoscopy as a diagnostic and therapeutic tool in post-bariatric surgery patients with chronic abdominal pain who had negative imaging and endoscopic studies.

Methods

A retrospective analysis was performed on post-bariatric surgery patients who underwent laparoscopy for diagnosis and treatment of chronic abdominal pain at a single academic center. Only patients with both negative preoperative CT scan and upper endoscopy were included.

Results

Total of 35 post-bariatric surgery patients met the inclusion criteria, and all had history of Roux-en-Y gastric bypass. Twenty out of 35 patients (57%) had positive findings on diagnostic laparoscopy including presence of adhesions (n = 12), chronic cholecystitis (n = 4), mesenteric defect (n = 2), internal hernia (n = 1), and necrotic omentum (n = 1). Two patients developed post-operative complications including a pelvic abscess and an abdominal wall abscess. Overall, 15 patients (43%) had symptomatic improvement after laparoscopy; 14 of these patients had positive laparoscopic findings requiring intervention (70% of the patients with positive laparoscopy). Conversely, 20 (57%) patients required long-term medical treatment for management of chronic abdominal pain.

Conclusion

Diagnostic laparoscopy, which is a safe procedure, can detect pathological findings in more than half of post-bariatric surgery patients with chronic abdominal pain of unknown etiology. About 40% of patients who undergo diagnostic laparoscopy and 70% of patients with positive findings on laparoscopy experience significant symptom improvement. Patients should be informed that diagnostic laparoscopy is associated with no symptom improvement in about half of cases.

Keywords

Bariatric surgery Diagnostic laparoscopy Abdominal pain Gastric bypass Complication Adhesion Internal hernia Endoscopy 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

For this type of study, formal consent is not required.

References

  1. 1.
    Ferguson IL. Laparoscopy for the diagnosis of nonspecific lower abdominal pain. Br J Clin Pract. 1974;28:163–5.PubMedGoogle Scholar
  2. 2.
    Togni R, Benetti-Pinto CL, Yela DA. The role of diagnostic laparoscopy in gynecology. Sao Paulo Med J. 2016;134:70–3.CrossRefPubMedGoogle Scholar
  3. 3.
    Pitt T, Brethauer S, Sherman V, et al. Diagnostic laparoscopy for chronic abdominal pain after gastric bypass. Surg Obes Relat Dis. 2008;4:394–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Nagy AG, James D. Diagnostic laparoscopy. Am J Surg. 1989;157:490–3.CrossRefPubMedGoogle Scholar
  5. 5.
    Klingensmith ME, Soybel DI, Brooks DC. Laparoscopy for chronic abdominal pain. Surg Endosc. 1996;10:1085–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Husain M, Sachan PK, Khan S, et al. Role of diagnostic laparoscopy in chronic and recurrent abdominal pain. Trop Gastroenterol. 2013;34:170–3.CrossRefPubMedGoogle Scholar
  7. 7.
    Salky BA, Edye MB. The role of laparoscopy in the diagnosis and treatment of abdominal pain syndromes. Surg Endosc. 1998;12:911–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Onders RP, Mittendorf EA. Utility of laparoscopy in chronic abdominal pain. Surgery. 2003;134:549–52.CrossRefPubMedGoogle Scholar
  9. 9.
    Paajanen H, Julkunen K, Waris H. Laparoscopy in chronic abdominal pain: a prospective nonrandomized long-term follow-up study. J Clin Gastroenterol. 2005;39:110–4.PubMedGoogle Scholar
  10. 10.
    Al-Mansour MR, Mundy R, Canoy JM, et al. Internal hernia after laparoscopic antecolic Roux-en-Y gastric bypass. Obes Surg. 2015;25:2106–11.CrossRefPubMedGoogle Scholar
  11. 11.
    Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003;13:350–4.CrossRefPubMedGoogle Scholar
  12. 12.
    Madan AK, Lo Menzo E, Dhawan N, et al. Internal hernias and nonclosure of mesenteric defects during laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2009;19:549–52.CrossRefPubMedGoogle Scholar
  13. 13.
    Iannelli A, Facchiano E, Gugenheim J. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2006;16:1265–71.CrossRefPubMedGoogle Scholar
  14. 14.
    Goudsmedt F, Deylgat B, Coenegrachts K, et al. Internal hernia after laparoscopic Roux-en-Y gastric bypass: a correlation between radiological and operative findings. Obes Surg. 2015;25:622–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Quezada N, Leon F, Jones A, et al. High frequency of internal hernias after Roux-en-Y gastric bypass. Obes Surg. 2015;25:615–21.CrossRefPubMedGoogle Scholar
  16. 16.
    Stephenson D, Moon RC, Teixeira AF, et al. Intussusception after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2014;10:666–70.CrossRefPubMedGoogle Scholar
  17. 17.
    Daellenbach L, Suter M. Jejunojejunal intussusception after Roux-en-Y gastric bypass: a review. Obes Surg. 2011;21:253–63.CrossRefPubMedGoogle Scholar
  18. 18.
    Mukerji AN, Shah A, Parithivel VS. Retrograde intussusception after Roux-en-Y gastric bypass. Am Surg. 2016;82:238–9.PubMedGoogle Scholar
  19. 19.
    Sujka J, Teixeira AF, Jawad MA. Suspected cecal volvulus as a reason for abdominal pain after gastric bypass: a case series. Surg Obes Relat Dis. 2015;11:978–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Ceppa FA, Gagne DJ, Papasavas PK, et al. Laparoscopic transgastric endoscopy after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3(1):21–4.CrossRefPubMedGoogle Scholar
  21. 21.
    Ivanecz A, Sremec M, Ceranic D, et al. Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: case report and review of the literature. World J Gastrointest Endosc. 2014;6:625–9.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Nguyen NT, Rivers R, Wolfe BM. Early gastrointestinal hemorrhage after laparoscopic gastric bypass. Obes Surg. 2003;13:62–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Kuga R, Safatle-Ribeiro AV, Faintuch J, et al. Endoscopic findings in the excluded stomach after Roux-en-Y gastric bypass surgery. Arch Surg. 2007;142:942–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Keren D, Madi H, Matter I, et al. Feasibility and importance of enteroscopy after gastric bypass. Obes Surg. 2016. doi: 10.1007/s11695-016-2472-x.
  25. 25.
    Silecchia G, Catalano C, Gentileschi P, et al. Virtual gastroduodenoscopy: a new look at the bypassed stomach and duodenum after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2002;12:39–48.CrossRefPubMedGoogle Scholar
  26. 26.
    Aminian A, Brethauer SA, Andalib A, et al. Can sleeve gastrectomy “cure” diabetes? Long-term metabolic effects of sleeve gastrectomy in patients with type 2 diabetes. Ann Surg. 2016;264:674–81.CrossRefPubMedGoogle Scholar
  27. 27.
    Aminian A, Brethauer SA, Sharafkhah M, et al. Development of a sleeve gastrectomy risk calculator. Surg Obes Relat Dis. 2015;11:758–64.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Mohammad Alsulaimy
    • 1
    • 2
  • Suriya Punchai
    • 1
    • 3
  • Fouzeyah A. Ali
    • 4
  • Matthew Kroh
    • 1
  • Philip R. Schauer
    • 1
  • Stacy A. Brethauer
    • 1
  • Ali Aminian
    • 1
    Email author
  1. 1.Bariatric and Metabolic Institute, Department of General SurgeryCleveland ClinicClevelandUSA
  2. 2.Department of Surgery & Urology, Al-Sabah Hospital, Ministry of HealthKuwaitKuwait
  3. 3.Department of Surgery, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand
  4. 4.Imaging Institute, Cleveland ClinicClevelandUSA

Personalised recommendations