Obesity Surgery

, Volume 28, Issue 9, pp 2609–2616 | Cite as

High-Frequency of Computer Tomography and Surgery for Abdominal Pain After Roux-en-Y Gastric Bypass

  • Jorunn SandvikEmail author
  • Torstein Hole
  • Christian A. Klöckner
  • Bård E. Kulseng
  • Arne Wibe
Original Contributions



Acute, intermittent, and chronic abdominal pain is a common complaint after Roux-en-Y gastric bypass (RYGB).


The aim of the study was to evaluate the use of medical imaging and the need for surgery treating abdominal pain after RYGB in a cohort with long-term follow-up.


Data from 569 patients who underwent RYGB as the primary bariatric procedure at a public hospital in Norway between April 2004 and June 2011 were prospectively registered in a local quality registry for bariatric surgery. All abdominal imaging and abdominal surgical procedures were registered until August 2017.


Mean follow-up was 100 months (61–159). During the observation period, 22% had one CT, 9% had two CTs, 4% had three CTs, and 5% had four or more CTs for abdominal pain. Twenty-two percent underwent abdominal surgery, as 16% had one and 6% had two or more operations and gynecological procedures excluded. The purpose of operation was postoperative complications (1.4%), suspected internal herniation (9.3%), cholecystectomy (9.3%), appendectomy (2.3%), hernias (3.2%), and perforated ulcer in the gastrojejunal anastomosis (0.7%). Mean time interval was 42 ± 27 months from RYGB to cholecystectomy and 51 ± 26 months for suspected IH.


With a mean follow-up period of more than 8 years after RYGB, 40% of the patients suffered from abdominal pain, needing one or more CT scans. The need for surgery treating suspected internal hernia and cholecystectomy was equal, at 9.3% for both procedures, but the mean time from RYGB to operation was shorter for cholecystectomies.


Roux-en-Y gastric bypass RYGB Abdominal pain CT Internal herniation Cholecystectomy Gallbladder disease Postbariatric 



This study was funded by a grant from More and Romsdal Hospital Trust.

Compliance with Ethical Standards

Ethical Approval

The study was evaluated by the Regional Ethics Committee (REK 2016/331) as a QUALITY improvement project and approved by the local Data Protection Officer. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. The Cochrane database of systematic reviews 2014(8):Cd003641. [published Online First: 2014/08/12]
  2. 2.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO Worldwide Survey 2014. Obes Surg. 2017;27(9):2279–89. [published Online First: 2017/04/14]
  3. 3.
    Angrisani L, Santonicola A, Iovino P, Formisano G., Buchwald H., Scopinaro N. Bariatric surgery worldwide 2013. Obesity surgery 2015;25(10):1822–32. [published Online First: 2015/04/04], 1832
  4. 4.
    Gribsholt SB, Svensson E, Richelsen B, et al. Rate of acute hospital admissions before and after Roux-en-Y gastric bypass surgery: a population-based cohort study. Ann Surg 2018;267(2):319–25. [published Online First: 2016/12/21]
  5. 5.
    Altieri MS, Pryor AD, Telem DA, et al. Algorithmic approach to utilization of CT scans for detection of internal hernia in the gastric bypass patient. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2015;11(6):1207–11. [published Online First: 2015/04/07]
  6. 6.
    Karila-Cohen P, Cuccioli F, Tammaro P, et al. Contribution of computed tomographic imaging to the management of acute abdominal pain after gastric bypass: correlation between radiological and surgical findings. Obesity surgery 2017;27(8):1961–72. [published Online First: 2017/02/24]
  7. 7.
    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(4):622–7. [published Online First: 2014/09/15]
  8. 8.
    Iannuccilli JD, Grand D, Murphy BL, et al. Sensitivity and specificity of eight CT signs in the preoperative diagnosis of internal mesenteric hernia following Roux-en-Y gastric bypass surgery. Clin Radiol. 2009;64(4):373–80. [published Online First: 2009/03/07]
  9. 9.
    Nau P, Molina G, Shima A, et al. Roux-en-Y gastric bypass is associated with an increased exposure to ionizing radiation. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2015;11(2):308–12. [published Online First: 2015/03/31]
  10. 10.
    Aghajani E, Nergaard BJ, Leifson BG, et al. The mesenteric defects in laparoscopic Roux-en-Y gastric bypass: 5 years follow-up of non-closure versus closure using the stapler technique. Surg Endosc. 2017;31:3743–8. [published Online First: 2017/02/17]
  11. 11.
    Jonas E, Marsk R, Rasmussen F, et al. Incidence of postoperative gallstone disease after antiobesity surgery: population-based study from Sweden. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2010;6(1):54–8. [published Online First: 2009/07/31]
  12. 12.
    Wanjura V, Sandblom G, Osterberg J, et al. Cholecystectomy after gastric bypass—incidence and complications. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2017;13(6):979–87. [published Online First: 2017/02/12]
  13. 13.
    Schulman AR, Thompson CC. Abdominal pain in the Roux-en-Y gastric bypass patient. Am J Gastroenterol. 2017; [published Online First: 2017/10/11]
  14. 14.
    Olbers T, Lonroth H, Fagevik-Olsen M, et al. Laparoscopic gastric bypass: development of technique, respiratory function, and long-term outcome. Obes Surg. 2003;13(3):364–70. [published Online First: 2003/07/05]
  15. 15.
    Madan AK, Frantzides CT. Triple-stapling technique for jejunojejunostomy in laparoscopic gastric bypass. Arch Surg. 2003;138(9):1029–32. [published Online First: 2003/09/10]
  16. 16.
    Haddad D, David A, Abdel-Dayem H, et al. Abdominal imaging post bariatric surgery: predictors, usage and utility. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2017;13(8):1327–36. [published Online First: 2017/06/14]
  17. 17.
    Geubbels N, Lijftogt N, Fiocco M, et al. Meta-analysis of internal herniation after gastric bypass surgery. Br J Surg. 2015;102(5):451–60. [published Online First: 2015/02/25]
  18. 18.
    Obeid NR, Malick W, Concors SJ, et al. Long-term outcomes after Roux-en-Y gastric bypass: 10- to 13-year data. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2016;12(1):11–20. [published Online First: 2015/09/28]
  19. 19.
    Stenberg E, Szabo E, Agren G, et al. Closure of mesenteric defects in laparoscopic gastric bypass: a multicentre, randomised, parallel, open-label trial. Lancet 2016;387(10026):1397–404. [published Online First: 2016/02/21]
  20. 20.
    Juo Y-Y, Khrucharoen U, Chen Y, et al. Cost analysis and risk factors for interval cholecystectomy after bariatric surgery: a national study. Surg Obes Relat Dis published online: November 20, 2017. DOI: doi:101016/jsoard201711.015
  21. 21.
    Geubbels N, Roell EA, Acherman YI, et al. Internal herniation after laparoscopic Roux-en-Y gastric bypass surgery: pitfalls in diagnosing and the introduction of the Amsterdam classification. Obesity surgery 2016;26(8):1859–66. [published Online First: 2016/01/21], 1866

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clinic of Medicine and RehabilitationMore and Romsdal Hospital TrustAlesundNorway
  2. 2.Center for Obesity, Department of SurgerySt. Olav Hospital, Trondheim University HospitalTrondheimNorway
  3. 3.Obesity Research Group at Department of Clinical and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
  4. 4.Department of Circulation and Medical Imaging, Faculty of Medicine and Health SciencesNTNU - Norwegian University of Science and TechnologyTrondheimNorway
  5. 5.Department of PsychologyNTNU - Norwegian University of Science and TechnologyTrondheimNorway
  6. 6.Department of Clinical and Molecular MedicineNTNU - Norwegian University of Science and TechnologyTrondheimNorway
  7. 7.Department of SurgerySt. Olav Hospital, Trondheim University HospitalTrondheimNorway

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