Abdominal Radiology

, Volume 37, Issue 5, pp 712–718 | Cite as

Complications of Roux-en-Y gastric bypass and sleeve gastrectomy

  • Daniel HerronEmail author
  • Ramin Roohipour


Roux-en-Y gastric bypass and sleeve gastrectomy are two of the most common bariatric procedures performed in 2011. Although the complication rates associated with these procedures are low, the consequences of these complications are significant and can be associated with high morbidity and mortality. Timely diagnosis and proper management of these complications are extremely important. The most commonly used radiologic studies in bariatric surgery are the upper GI contrast study and the CT scan, which are used to rule out leak, obstruction, perforation, anastomotic stricture, or pouch dilatation. As with all imaging studies, a negative result should not override strong clinical suspicion of a complication.


Gastric bypass Sleeve gastrectomy Complication Upper GI contrast study CT scan Bariatric surgery 


Conflict of interest

Dr. Herron receives a restricted education grant from Covidien, Inc. Dr. Roohipour reports no conflicts of interest.


  1. 1.
    Birkmeyer NJO, Dimick JB, Share D, et al. (2010) Hospital complication rates with bariatric surgery in Michigan. JAMA 304:435–442CrossRefPubMedGoogle Scholar
  2. 2.
    American Society for Metabolic and Bariatric Surgery. (2009). Accessed 23 March 2011
  3. 3.
    Samuel I, Mason EE, Renquist KE, et al. (2006) Bariatric surgery trends: an 18-year report from the International Bariatric Surgery Registry. Am J Surg 192(5):657–662CrossRefPubMedGoogle Scholar
  4. 4.
    Buchwald H, Oien DM (2009) Metabolic/bariatric surgery worldwide 2008. Obes Surg 19(12):1605–1611CrossRefPubMedGoogle Scholar
  5. 5.
    Silecchia G, Boru C, Pecchia A, et al. (2006) Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg 16:1138–1144CrossRefPubMedGoogle Scholar
  6. 6.
    Adams TD, Gress RE, Smith SC, et al. (2007) Long-term mortality after gastric bypass surgery. N Engl J Med 357(8):753–761CrossRefPubMedGoogle Scholar
  7. 7.
    Sjöström L, Narbro K, Sjöström CD, et al. (2007) Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 357(8):741–752CrossRefPubMedGoogle Scholar
  8. 8.
    Inabnet WB, Belle SH, Bessler M, et al. (2010) Comparison of 30-day outcomes after non-LapBand primary and revisional surgical procedures from the Longitudinal Assessment of Bariatric Surgery study. Surg Obes Rel Dis 6:22–30CrossRefGoogle Scholar
  9. 9.
    LABS Consortium Writing Group (2009) Perioperative safety in the Longitudinal Assessment of Bariatric Surgery. New Engl J Med 361:445–454CrossRefGoogle Scholar
  10. 10.
    Calmes JM, Giusti V, Suter M (2005) Reoperative laparoscopic Roux-en-Y gastric bypass: an experience with 49 cases. Obes Surg 15:316–322CrossRefPubMedGoogle Scholar
  11. 11.
    Morales MP, Wheeler AA, Ramaswamy A, Scott JS, de la Torre RA (2010) Laparoscopic revisional surgery after Roux-en-Y gastric bypass and sleeve gastrectomy. Surg Obes Relat Dis 6:485–490CrossRefPubMedGoogle Scholar
  12. 12.
    Ballesta C, Berindoague R, Cabrera M, Palau M, Gonzales M (2008) Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass. Obes Surg 18:623–630CrossRefPubMedGoogle Scholar
  13. 13.
    Gonzalez R, Sarr MG, Smith CD, et al. (2007) Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg 204:47–55CrossRefPubMedGoogle Scholar
  14. 14.
    Bellorin O, Abdemur A, Sucandy I, et al. (2011) Understanding the significance, reasons and patterns of abnormal vital signs after gastric bypass for morbid obesity. Obes Surg 21:707–713CrossRefPubMedGoogle Scholar
  15. 15.
    Fullum TM, Aluka KJ, Turner PL (2009) Decreasing anastomotic and staple line leaks after laparoscopic Roux-en-Y gastric bypass. Surg Endosc 23:1403–1408CrossRefPubMedGoogle Scholar
  16. 16.
    Podnos YD, Jimenez JC, Wilson SE, et al. (2003) Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg 138:957–961CrossRefPubMedGoogle Scholar
  17. 17.
    Kothari SN, Kallies KJ, Mathiason MA, et al. (2010) Excellent laparoscopic gastric bypass outcomes can be achieved at a community-based training hospital with moderate case volume. Ann Surg 252:43–49CrossRefPubMedGoogle Scholar
  18. 18.
    Chen B, Kiriakopoulos A, Tsakayannis D, et al. (2009) Reinforcement does not necessarily reduce the rate of staple line leaks after sleeve gastrectomy. A review of the literature and clinical experiences. Obes Surg 19:166–172CrossRefPubMedGoogle Scholar
  19. 19.
    Burgos AM, Braghetto I, Csendes A, et al. (2009) Gastric leak after laparoscopic sleeve gastrectomy for obesity. Obes Surg 19:1672–1677CrossRefPubMedGoogle Scholar
  20. 20.
    Doraiswamy A, Rasmussen JJ, Pierce J, et al. (2007) The utility of routine postoperative upper GI series following laparoscopic gastric bypass. Surg Endosc 21:2159–2162CrossRefPubMedGoogle Scholar
  21. 21.
    Madan AK, Stoecklein HH, Ternovits CA, et al. (2007) Predictive value of upper gastrointestinal studies versus clinical signs for gastrointestinal leaks after laparoscopic gastric bypass. Surg Endosc 21:194–196CrossRefPubMedGoogle Scholar
  22. 22.
    ASMBS Clinical Issues Committee (2009) ASMBS guideline on the prevention and detection of gastrointestinal leak after gastric bypass including the role of imaging and surgical exploration. Surg Obes Relat Dis 5(3):293–296CrossRefGoogle Scholar
  23. 23.
    Shah S, Shah V, Ahmed AR (2011) Imaging in bariatric surgery: service set-up, post-operative anatomy and complications. Br J Radiol 84:101–111CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Blackmon SH, Santora R, Schwarz P, Barroso A, Dunkin BJ (2010) Utility of removable esophageal covered self-expanding metal stents for leak and fistula management. Ann Thorac Surg 89:931–936CrossRefPubMedGoogle Scholar
  25. 25.
    Tan JT, Kariyawasam S, Wijeratne T, Chandraratna HS (2010) Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg 20(4):403–409CrossRefPubMedGoogle Scholar
  26. 26.
    Bakhos C, Alkhoury F, Kyriakides T, Reinhold R, Nadzam G (2009) Early post-operative hemorrhage after open and laparoscopic Roux-en-Y gastric bypass. Obes Surg 2:153–577CrossRefGoogle Scholar
  27. 27.
    Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J (2000) Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232:515–529CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Dick A, Byrne TK, Baker M, Budak A, Morgan K (2010) Gastrointestinal bleeding after gastric bypass surgery: nuisance or catastrophe? Surg Obes Relat Dis 6:643–647CrossRefPubMedGoogle Scholar
  29. 29.
    Kothari SN (2011) Bariatric surgery and postoperative imaging. Surg Clin North Am 91:155–172CrossRefPubMedGoogle Scholar
  30. 30.
    Siilin H, Wanders A, Gustavsson S, Sundbom M (2005) The proximal gastric pouch invariably contains acid-producing parietal cells in Roux-en-Y gastric bypass. Obes Surg 15:771–777CrossRefPubMedGoogle Scholar
  31. 31.
    Sapala JA, Wood MH, Schuhknecht MP, et al. (2003) Fatal pulmonary embolism after bariatric operations for morbid obesity: a 24-year retrospective analysis. Obes Surg 13:819–825CrossRefPubMedGoogle Scholar
  32. 32.
    Husain S, Ahmed AR, Johnson J, Boss T, O’Malley W (2007) Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass: aetiology, diagnosis, and management. Arch Surg 142:988–993CrossRefPubMedGoogle Scholar
  33. 33.
    Champion JK, Williams M (2003) Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg 13:596–600CrossRefPubMedGoogle Scholar
  34. 34.
    Nguyen NT, Huerta S, Gelfand D, Stevens CM, Jim J (2004) Bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Obes Surg 14:190–196CrossRefPubMedGoogle Scholar
  35. 35.
    Hwang RF, Swartz DE, Felix EL (2004) Causes of small bowel obstruction after laparoscopic gastric bypass. Surg Endosc 18:1631–1635CrossRefPubMedGoogle Scholar
  36. 36.
    Cho M, Carrodeguas L, Pinto D, et al. (2006) Diagnosis and management of partial small bowel obstruction after laparoscopic antecolic antegastric Roux-en-Y gastric bypass for morbid obesity. J Am Coll Surg 202:262–268CrossRefPubMedGoogle Scholar
  37. 37.
    Felsher J, Brodsky J (2003) Small bowel obstruction after laparoscopic Roux-en-y gastric bypass. Surgery 134:501–505CrossRefPubMedGoogle Scholar
  38. 38.
    Chandler RC, Srinivas G, Chintapalli KN, Schwesinger WH, Prasad SR (2008) Imaging in bariatric surgery: a guide to postsurgical anatomy and common complications. AJR Am J Roentgenol 190:122–135CrossRefPubMedGoogle Scholar
  39. 39.
    Blachar A, Federle MP, Pealer KM, Ikramuddin S, Schauer PR (2002) Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology 223:625–632CrossRefPubMedGoogle Scholar
  40. 40.
    Higa KD, Ho T, Boone KB (2003) Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg 13:350–354CrossRefPubMedGoogle Scholar
  41. 41.
    Comeau E, Gagner M, Inabnet WB, et al. (2005) Symptomatic internal hernias after laparoscopic bariatric surgery. Surg Endosc 19:34–39CrossRefPubMedGoogle Scholar
  42. 42.
    de la Cruz-Muñoz N, Cabrera JC, Cuesta M (2011) Closure of mesenteric defect can lead to decrease in internal hernias after Roux-en-Y gastric bypass. Surg Obes Relat Dis 7:176–180CrossRefPubMedGoogle Scholar
  43. 43.
    Carmody B, Demaria EJ, Jamal M (2005) Internal hernia after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 188:543–548CrossRefGoogle Scholar
  44. 44.
    Iannuccilli JD, Grand D, Murphy BL, et al. (2009) Sensitivity and specificity of eight CT signs in the preoperative diagnosis of internal mesenteric hernia following Roux-en-Y gastric bypass surgery. Clin Radiol 64:373–380CrossRefPubMedGoogle Scholar
  45. 45.
    Carrodeguas L, Szomstein S, Zundel N, Lo Menzo E, Rosenthal R (2006) Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass surgery: analysis of 1291 patients. Surg Obes Relat Dis 2:92–97CrossRefPubMedGoogle Scholar
  46. 46.
    Cusati D, Sarr M, Kendrick M, Que F, Swain JM (2011) Refractory strictures after Roux-en-Y gastric bypass: operative management. Surg Obes Relat Dis 7:165–169CrossRefPubMedGoogle Scholar
  47. 47.
    Nguyen NT, Stevens CM, Wolfe BM (2003) Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass. J Gastrointest Surg 7:997–1003CrossRefPubMedGoogle Scholar
  48. 48.
    Gonzalez R, Lin E, Venkatesh KR, et al. (2003) Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques. Arch Surg 138:181–184CrossRefPubMedGoogle Scholar
  49. 49.
    Takata MC, Ciovica R, Cello JP, et al. (2007) Predictors treatment, and outcomes of gastrojejunostomy stricture after gastric bypass for morbi obesity. Obes Surg 17:878–884CrossRefPubMedGoogle Scholar
  50. 50.
    Trulzsch DV, Penmetsa A, Karim A, Evans DA (1992) Gastrografin-induced aspiration pneumonia: a lethal complication of computed tomography. South Med J 85:1255–1256CrossRefPubMedGoogle Scholar
  51. 51.
    Da Costa M, Mata A, Espinós J (2011) Endoscopic dilation of gastrojejunal anastomotic strictures after laparoscopic gastric bypass: predictors of initial failure. Obes Surg 21:36–41CrossRefPubMedGoogle Scholar
  52. 52.
    Coster DD, Sundberg SM, Kermode DS, et al. (2008) Small bowel obstruction due to antegrade and retrograde intussusception after gastric bypass: three case reports in two patients, literature review, and recommendations for diagnosis and treatment. Surg Obes Relat Dis 4:69–72CrossRefPubMedGoogle Scholar
  53. 53.
    Simper SC, Erzinger JM, McKinlay RD, et al. (2008) Retrograde (reverse) jejunal intussusception might not be such a rare problem: a single group’s experience of 23 cases. Surg Obes Relat Dis 4:77–83CrossRefPubMedGoogle Scholar
  54. 54.
    Gumbs AA, Duffy AJ, Bell RL (2006) Management of gastrogastric fistula after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2:117–121CrossRefPubMedGoogle Scholar
  55. 55.
    Carrodeguas L, Szomstein S, Soto F, et al. (2005) Management of gastrogastric fistulas after divided Roux-en-Y gastric bypass surgery for morbid obesity: analysis of 1,292 consecutive patients and review of literature. Surg Obes Relat Dis 1:467–474CrossRefPubMedGoogle Scholar
  56. 56.
    Gustavsson S, Sundbom M (2003) Excellent weight result after Roux-en-Y gastric bypass in spite of gastro-gastric fistula. Obes Surg 13:457–459CrossRefPubMedGoogle Scholar
  57. 57.
    Katz DP, Lee SR, Nachiappan AC, et al. (2011) Laparoscopic sleeve gastrectomy: a guide to postoperative anatomy and complications. Abdom Imaging 36:363–371CrossRefPubMedGoogle Scholar
  58. 58.
    Bellanger DE, Greenway FL (2011) Laparoscopic sleeve gastrectomy, 529 cases without a leak: short-term results and technical considerations. Obes Surg 21:146–150CrossRefPubMedGoogle Scholar
  59. 59.
    Gumbs AA, Gagner M, Dakin G, Pomp A (2007) Sleeve gastrectomy for morbid obesity. Obes Surg 17:962–969CrossRefPubMedGoogle Scholar
  60. 60.
    Iannelli A, Schneck AS, Noel P, et al. (2011) Re-sleeve gastrectomy for failed laparoscopic sleeve gastrectomy: a feasibility study. Obes Surg 21:832–835CrossRefPubMedGoogle Scholar
  61. 61.
    Baltasar A, Serra C, Pérez N, Bou R, Bengochea M (2006) Re-sleeve gastrectomy. Obes Surg 16:1535–1538CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of SurgeryMount Sinai School of MedicineNew YorkUSA
  2. 2.Association of Southbay SurgeonsTorranceUSA

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