Roux-en-Y gastric bypass (RYGB) remains one of the key bariatric procedures worldwide. In addition to bleeding and anastomotic leak, there are rarely occurring complications such as obstruction at the jejuno-jejunostomy in the early postoperative phase.
Patient and Methods
A 51-year-old lady (weight 122 kg; BMI 46 kg/m2; with type 2 diabetes mellitus and hypertension) underwent RYGB in our tertiary referral centre 3 days prior to admission. She originally recovered well from the uneventful operation, but began vomiting on day 3. At this point, she complained of no other symptoms. An urgent CT scan identified a gastric remnant dilatation, and an obstructed jejuno-jejunostomy. An urgent laparoscopic exploration was performed, which identified obstruction at this level.
Within our video-presentation, detailed technical steps are described. First, gastric remnant decompression was performed by inserting a tube gastrostomy. Secondly, the obstruction was identified. Consequently, a new jejuno-jejunostomy was created, proximal to the original anastomosis, using a linear stapler, and direct suture closure of the enterotomy defects. After thorough washout, drains were placed in the pelvis and alongside the jejuno-jejunostomy. The patient was discharged home after a 2-week hospital stay which included 5 days of invasive ventilation on the ITU.
A high-level of suspicion is required to suspect, diagnose and treat post-RYGB complications. A bariatric on-call rota with appropriately trained personnel is essential.
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Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.
Vasas P, Al-Khyatt W, Idris I, et al. Mid-term remission of type 2 diabetes mellitus after laparoscopic Roux-En-Y gastric bypass. World J Surg. 2016;40(11):2719–25.
Jones KB. Biliopancreatic limb obstruction in gastric bypass at or proximal to the jejunojejunostomy: a potentially deadly, catastrophic event. Obes Surg. 1996;6(6):485–93.
Khoraki J, Mazzini GS, Shah AS, et al. Early small bowel obstruction after laparoscopic gastric bypass: a surgical emergency. Surg Obes Relat Dis. 2018;14(8):1118–25.
Peeters G, Gys T, Lafullarde T. Small bowel obstruction after laparoscopic roux-en-Y gastric bypass caused by an intraluminal blood clot. Obes Surg. 2009;19(4):521–3.
Conflict of Interest
The authors declare that they have no conflict of interest.
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.
Informed consent for the operation was obtained from the patient included in this paper.
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Vasas, P., Hussain, A., Owers, C. et al. What Every Bariatric Surgeon Should Know: How to Relieve Obstruction at the Jejuno-jejunostomy After Roux-en-Y Gastric Bypass. OBES SURG 29, 3089–3090 (2019) doi:10.1007/s11695-019-04031-y
- Roux-en-Y gastric bypass
- Bariatric surgery
- Bowel obstruction