Roux-en-Y gastric bypass (RYGB) remains the gold standard procedure for weight loss surgery. In spite of the technical challenges of this procedure, the incidence of complications has dramatically decreased with surgeons’ experience and the implementation of “Centers of Excellence.” Nevertheless, complications are still described in both the intraoperative and postoperative periods. The widespread use of such procedures requires a thorough knowledge of the possible complications even for the “non-bariatric” general surgeon. Some of the complications, if not recognized and managed expeditiously, can potentially lead to devastating consequences, such as short bowel syndrome, permanent neurological damages, and death.
We describe the most common complications occurring after RYGB with their diagnostic and therapeutic approach.
Gastric bypass Complications Leak after gastric bypass Marginal ulcer Bariatric surgery
This is a preview of subscription content, log in to check access.
Laproscopic transection of gastro-gastric fistula with oversewing of the gastric remnant and pouch (MOV 1301462 kb)
Hinojosa MW, Varela JE, Parikh D, Smith BR, Nguyen XM, Nguyen NT. National trends in use and outcome of laparoscopic adjustable gastric banding. Surg Obes Relat Dis. 2009;5(2):150–5.CrossRefPubMedGoogle Scholar
Kligman MD. Intraoperative endoscopic pneumatic testing for gastrojejunal anastomotic integrity during laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21(8):1403–5.CrossRefPubMedGoogle Scholar
Frantz DJ. Neurologic complications of bariatric surgery: involvement of central, peripheral, and enteric nervous systems. Curr Gastroenterol Rep. 2012;14(4):367–72.CrossRefPubMedGoogle Scholar
Ettinger JE, MarcíliodeSouza CA, Azaro E, Mello CA, Santos-Filho PV, Orrico J, et al. Clinical features of rhabdomyolysis after open and laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18(6):635–43.CrossRefPubMedGoogle Scholar
Edwards MA, Jones DB, Ellsmere J, Grinbaum R, Schneider BE. Anastomotic leak following antecolic versus retrocolic laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2007;17(3):292–7.CrossRefPubMedGoogle Scholar
Ballesta C, Berindoague R, Cabrera M, Palau M, Gonzales M. Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18(6):623–30.CrossRefPubMedGoogle Scholar
Gonzalez R, Sarr MG, Smith CD, Baghai M, Kendrick M, Szomstein S, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg. 2007;204(1):47–55.CrossRefPubMedGoogle Scholar
Flicker MS, Lautz DB, Thompson CC. Endoscopic management of gastrogastric fistulae does not increase complications at bariatric revision surgery. J Gastrointest Surg. 2011;15(10):1736–42.CrossRefPubMedGoogle Scholar
Cho M, Kaidar-Person O, Szomstein S, Rosenthal RJ. Laparoscopic remnant gastrectomy: a novel approach to gastrogastric fistula after Roux-en-Y gastric bypass for morbid obesity. J Am Coll Surg. 2007;204(4):617–24.CrossRefPubMedGoogle Scholar
Griffith PS, Birch DW, Sharma AM, Karmali S. Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity. Can J Surg. 2012;55(5):329–36.CrossRefPubMedCentralPubMedGoogle Scholar
Tucker ON, Escalante-Tattersfield T, Szomstein S, Rosenthal RJ. The ABC System: a simplified classification system for small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17(12):1549–54.CrossRefPubMedGoogle Scholar
Rosenthal RJ. Dilating the stenotic gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass for morbid obesity: when things go wrong. J Gastrointest Surg. 2009;13(9):1561–3.CrossRefPubMedGoogle Scholar
Nandipati KC, Lin E, Husain F, Srinivasan J, Sweeney JF, Davis SS. Counterclockwise rotation of Roux-en-Y limb significantly reduces internal herniation in laparoscopic Roux-en-Y gastric bypass (LRYGB). J Gastrointest Surg. 2012;16(4):675–81.CrossRefPubMedGoogle Scholar
Owens M, Barry M, Janjua AZ, Winter DC. A systematic review of laparoscopic port site hernias in gastrointestinal surgery. Surgeon. 2011;9(4):218–24.CrossRefPubMedGoogle Scholar
Ver SK. Retrograde intussusception following Roux-en-Y gastric bypass. Obes Surg. 2006;16(8):1101–3.CrossRefGoogle Scholar
Edwards MA, Grinbaum R, Ellsmere J, Jones DB, Schneider BE. Intussusception after Roux-en-Y gastric bypass for morbid obesity: case report and literature review of rare complication. Surg Obes Relat Dis. 2006;2(4):483–9.CrossRefPubMedGoogle Scholar
Simper SC, Erzinger JM, McKinlay RD, Smith SC. Retrograde (reverse) jejunal intussusception might not be such a rare problem: a single group’s experience of 23 cases. Surg Obes Relat Dis. 2008;4(2):77–83.CrossRefPubMedGoogle Scholar
Matlaga BR, Shore AD, Magnuson T, Clark JM, Johns R, Makary MA. Effect of gastric bypass surgery on kidney stone disease. J Urol. 2009;181(6):2573–7.CrossRefPubMedGoogle Scholar
Mathavan VK, Arregui M, Davis C, Singh K, Patel A, Meacham J. Management of postgastric bypass noninsulinoma pancreatogenous hypoglycemia. Surg Endosc. 2010;24(10):2547–55.CrossRefPubMedGoogle Scholar