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Small bowel obstruction following laparoscopic Roux-en-Y gastric bypass: is it always necessary to operate? A 5-year, high volume center experience

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Abstract

Purpose

This study aims to describe the incidence, associated factors, etiology, and management of small bowel obstructions following laparoscopic Roux-en-Y gastric bypass (LRYGB).

Methods

A retrospective analysis was conducted between January 15 and December 19 using the surgery database of our hospital. Included LRYGB patients were those that evolved with a prolonged length of stay; readmission; emergency room consult; and re-intervention due to small bowel obstruction (SBO) related symptoms with compatible radiological or intraoperative findings. The LRYGB technique implied an antecolic alimentary limb reconstruction and systematic closure of mesenteric defects. Descriptive and analytical statistics were carried out, using a parametric or non-parametric approach as needed.

Results

Nine hundred forty-one LRYGB were performed. 9.9% were revisional surgeries of patients with a laparoscopic sleeve gastrectomy. During the study period, 36 SBOs occurred, representing 3.8% of operated patients, with no mortality. 58.3% had successful non-operative management, while 41.7% required surgical exploration, of which 73.3% were treated laparoscopically and 20% needed conversion to open surgery. Etiologies of SBO were jejuno-jejunostomy (JJO) related stenosis (22, 61.1%), internal hernias (6, 16.7%), adherences (3, 8.3%), and other diagnoses (5, 13.9%). Regarding JJO stenosis and internal hernias, median time to diagnosis was 8 days (IQR 7–11) and 12 months (IQR 8.7–16) respectively. Previous sleeve gastrectomy, age, or sex was not associated to the incidence of small bowel obstruction.

Conclusions

LRYGB is safe when performed by experienced surgeons. SBO due to internal hernias were scarce in this series. JJO stenosis could explain most cases of SBO; under this diagnosis, non-surgical management was successful frequently.

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Data availability

Data will not be submitted to a public repository.

Code availability

Statistical analysis was made using the STATA13® software.

References

  1. Colquitt JL, Pickett K, Loveman E, Frampton GK (2014) Surgery for weight loss in adults. Cochrane Database Syst Rev (8):CD003641. https://doi.org/10.1002/14651858.CD003641.pub4

  2. Angrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J, Buchwald H, Scopinaro N (2018) IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg 28(12):3783–3794. https://doi.org/10.1007/s11695-018-3450-2

    Article  PubMed  Google Scholar 

  3. Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL, Nanjee MN, Gutierrez JM, Frogley SJ, Ibele AR, Brinton EA, Hopkins PN, McKinlay R, Simper SC, Hunt SC (2017) Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med 377(12):1143–1155. https://doi.org/10.1056/NEJMoa1700459

    Article  PubMed  PubMed Central  Google Scholar 

  4. Rausa E, Bonavina L, Asti E, Gaeta M, Ricci C (2016) Rate of death and complications in laparoscopic and open Roux-en-Y gastric bypass. A meta-analysis and meta-regression analysis on 69,494 patients. Obes Surg 26(8):1956–63. https://doi.org/10.1007/s11695-016-2231-z

    Article  PubMed  Google Scholar 

  5. Hamdan K, Somers S, Chand M (2011) Management of late postoperative complications of bariatric surgery. Br J Surg 98(10):1345–55. https://doi.org/10.1002/bjs.7568

    Article  CAS  PubMed  Google Scholar 

  6. Peterli R, Wölnerhanssen BK, Peters T, Vetter D, Kröll D, Borbély Y, Schultes B, Beglinger C, Drewe J, Schiesser M, Nett P, Bueter M (2018) Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA 319(3):255–265. https://doi.org/10.1001/jama.2017.20897

    Article  PubMed  PubMed Central  Google Scholar 

  7. Acquafresca PA, Palermo M, Rogula T, Duza GE, Serra E (2015) Early surgical complications after gastric by-pass: a literature review. Arq Bras Cir Dig 28(1):74–80. https://doi.org/10.1590/S0102-67202015000100019

    Article  PubMed  PubMed Central  Google Scholar 

  8. Abasbassi M, Pottel H, Deylgat B, Vansteenkiste F, Van Rooy F, Devriendt D, D’Hondt M (2011) Small bowel obstruction after antecolic antegastric laparoscopic Roux-en-Y gastric bypass without division of small bowel mesentery: a single-centre, 7-year review. Obes Surg 21(12):1822–7. https://doi.org/10.1007/s11695-011-0462-6

    Article  PubMed  Google Scholar 

  9. Elms L, Moon RC, Varnadore S, Teixeira AF, Jawad MA (2014) Causes of small bowel obstruction after Roux-en-Y gastric bypass: a review of 2,395 cases at a single institution. Surg Endosc 28(5):1624–8. https://doi.org/10.1007/s00464-013-3361-1

    Article  PubMed  Google Scholar 

  10. Koppman JS, Li C, Gandsas A (2008) Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass: a review of 9,527 patients. J Am Coll Surg 206(3):571–84. https://doi.org/10.1016/j.jamcollsurg.2007.10.008

    Article  PubMed  Google Scholar 

  11. Quezada N, León F, Jones A, Varas J, Funke R, Crovari F, Raddatz A, Pérez G, Escalona A, Boza C (2015) High frequency of internal hernias after Roux-en-Y gastric bypass. Obes Surg 25(4):615–21. https://doi.org/10.1007/s11695-014-1302-2

    Article  PubMed  Google Scholar 

  12. Stenberg E, Szabo E, Ågren G, Ottosson J, Marsk R, Lönroth H, Boman L, Magnuson A, Thorell A, Näslund I (2016) Closure of mesenteric defects in laparoscopic gastric bypass: a multicentre, randomised, parallel, open-label trial. Lancet 387(10026):1397–1404. https://doi.org/10.1016/S0140-6736(15)01126-5

    Article  PubMed  Google Scholar 

  13. Escalona A, Devaud N, Pérez G, Crovari F, Boza C, Viviani P, Ibáñez L, Guzmán S (2007) Antecolic versus retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass: a comparative study. Surg Obes Relat Dis 3(4):423–427. https://doi.org/10.1016/j.soard.2007.04.005

    Article  PubMed  Google Scholar 

  14. Wehrtmann FS, de la Garza JR, Kowalewski KF, Schmidt MW, Müller K, Tapking C, Probst P, Diener MK, Fischer L, Müller-Stich BP, Nickel F (2020) Learning curves of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in bariatric surgery: a systematic review and introduction of a standardization. Obes Surg 30(2):640–656. https://doi.org/10.1007/s11695-019-04230-7

    Article  CAS  PubMed  Google Scholar 

  15. Higa KD, Boone KB, Ho T, Davies OG (2000) Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. Arch Surg 135(9):1029–33. https://doi.org/10.1001/archsurg.135.9.1029 (discussion 1033–4 PMID: 10982506.y. Arch Surg. 2000;135:1029–1034. doi:10.1007/s10353-006-0293-1)

    Article  CAS  PubMed  Google Scholar 

  16. Nguyen NT, Paya M, Stevens CM, Mavandadi S, Zainabadi K, Wilson SE (2004) The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Ann Surg 240(4):586–93. https://doi.org/10.1097/01.sla.0000140752.74893.24

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gribsholt SB, Svensson E, Richelsen B, Raundahl U, Sørensen HT, Thomsen RW (2018) Rate of acute hospital admissions before and after Roux-en-Y gastric bypass surgery: a population-based cohort study. Ann Surg 267(2):319–325. https://doi.org/10.1097/SLA.0000000000002113

    Article  PubMed  Google Scholar 

  18. Saunders J, Ballantyne GH, Belsley S, Stephens DJ, Trivedi A, Ewing DR, Iannace VA, Capella RF, Wasileweski A, Moran S, Schmidt HJ (2008) One-year readmission rates at a high volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and vertical banded gastroplasty-Roux-en-Y gastric bypass. Obes Surg 18(10):1233–40. https://doi.org/10.1007/s11695-008-9517-8

    Article  PubMed  Google Scholar 

  19. Hwang RF, Swartz DE, Felix EL (2004) Causes of small bowel obstruction after laparoscopic gastric bypass. Surg Endosc 18(11):1631–5. https://doi.org/10.1007/s00464-004-8804-2

    Article  CAS  PubMed  Google Scholar 

  20. Kassir R, Debs T, Ben Amor I, Tiffet O, Blanc P, Caldwell J, Iannelli A, Gugenheim J (2014) Management of complications following bariatric surgery: summary. Int J Surg 12(12):1462–1464. https://doi.org/10.1016/j.ijsu.2014.11.009

    Article  PubMed  Google Scholar 

  21. Aghajani E, Nergaard BJ, Leifson BG, Hedenbro J, Gislason H (2017) 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 31(9):3743–3748. https://doi.org/10.1007/s00464-017-5415-2

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gunabushanam G, Shankar S, Czerniach DR, Kelly JJ, Perugini RA (2009) Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass surgery. J Comput Assist Tomogr 33(3):369–375. https://doi.org/10.1097/RCT.0b013e31818803ac

    Article  PubMed  Google Scholar 

  23. Roberts KE, Renee Hilton L, Friedman DT, Frieder JS, Zhang X, Duffy AJ (2019) Safety and Feasibility of a Lower-Cost Stapler in Bariatric Surgery. Obes Surg 29(2):401–405. https://doi.org/10.1007/s11695-018-3580-6

    Article  PubMed  Google Scholar 

  24. Schneider C, Cobb W, Scott J, Carbonell A, Myers K, Bour E (2011) Rapid excess weight loss following laparoscopic gastric bypass leads to increased risk of internal hernia. Surg Endosc 25(5):1594–8. https://doi.org/10.1007/s00464-010-1444-9

    Article  PubMed  Google Scholar 

  25. Vidal P, Ramón JM, Goday A, Parri A, Crous X, Trillo L, Pera M, Grande L (2014) Lack of adherence to follow-up visits after bariatric surgery: reasons and outcome. Obes Surg 24(2):179–83. https://doi.org/10.1007/s11695-013-1094-9

    Article  PubMed  Google Scholar 

  26. Wheeler E, Prettyman A, Lenhard MJ, Tran K (2008) Adherence to outpatient program postoperative appointments after bariatric surgery. Surg Obes Relat Dis 4(4):515–520. https://doi.org/10.1016/j.soard.2008.01.013

    Article  PubMed  Google Scholar 

  27. Moroshko I, Brennan L, O’Brien P (2012) Predictors of attrition in bariatric aftercare: a systematic review of the literature. Obes Surg 22(10):1640–7. https://doi.org/10.1007/s11695-012-0691-3

    Article  PubMed  Google Scholar 

  28. Levine MS, Carucci LR (2014) Imaging of bariatric surgery: normal anatomy and postoperative complications. Radiology 270(2):327–41. https://doi.org/10.1148/radiol.13122520

    Article  PubMed  Google Scholar 

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Funding

This research was funded by our Digestive Surgery Department.

Author information

Authors and Affiliations

  1. Digestive Surgery Department, Surgery Division, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile

    Mauricio Gabrielli, Pablo Achurra, Rodrigo Muñoz, Nicolas Quezada & Fernando Crovari

  2. Surgery Division, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile

    Cristian Jarry

  3. Faculty of Medicine, Pontificia Universidad Católica de Chile, Avda. Libertador Bernando O’Higgins 340, Santiago, Chile

    Sebastián Hurtado

Authors
  1. Mauricio Gabrielli
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  2. Cristian Jarry
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  3. Sebastián Hurtado
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  4. Pablo Achurra
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  5. Rodrigo Muñoz
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  6. Nicolas Quezada
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  7. Fernando Crovari
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Contributions

Mauricio Gabrielli and Cristian Jarry contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Sebastian Hurtado and Cristian Jarry. The first draft of the manuscript was written by Mauricio Gabrielli, Cristian Jarry, and Sebastian Hurtado. All authors contributed to the editing and review of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mauricio Gabrielli.

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Ethics approval and consent to participate

Our local Institutional Review Board (Comité de Ética Investigación PUC) reviewed and approved this research. In view of the retrospective nature of the study and as all the procedures performed were part of the routine care, no informed consent was required.

Competing interests

The authors declare no competing interests.

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Gabrielli, M., Jarry, C., Hurtado, S. et al. Small bowel obstruction following laparoscopic Roux-en-Y gastric bypass: is it always necessary to operate? A 5-year, high volume center experience. Langenbecks Arch Surg 406, 1839–1846 (2021). https://doi.org/10.1007/s00423-021-02262-1

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