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Gastrointestinal Obstruction in the Bypass Patient

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Bariatric Surgery Complications and Emergencies

Abstract

The objective of this chapter is to explore the various causes of gastrointestinal obstruction in the post-gastric bypass patient. Anatomic alterations following Roux-en-Y gastric bypass surgery can result in bowel obstructions that pose both a diagnostic and therapeutic dilemma for surgeons. The risk of progression to bowel ischemia because of delayed treatment underscores the importance of properly identifying and treating bowel obstructions early in this patient population.

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References

  1. Abasbassi M, Pottel H, Deylgat B, Vansteenkiste F, Van Rooy F, Devriendt D, et al. 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. 2011;21(12):1822–7.

    Article  PubMed  Google Scholar 

  2. Cho M, Carrodeguas L, Pinto D, Lascano C, Soto F, Whipple O, et al. Diagnosis and management of partial small bowel obstruction after laparoscopic antecolic antegastric Roux-en-Y gastric bypass for morbid obesity. J Am Coll Surg. 2006;202(2):262–8.

    Article  PubMed  Google Scholar 

  3. Nguyen NT, Huerta S, Gelfand D, Stevens CM, Jim J. Bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2004;14(2):190–6.

    Article  PubMed  Google Scholar 

  4. Koppman JS, Li C, Gandsas A. Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass: a review of 9527 patients. J Am Coll Surg. 2008;206(3):571–84.

    Article  PubMed  Google Scholar 

  5. Rodriguez A, Mosti M, Sierra M, Perez-Johnson R, Flores S, Dominguez G, et al. Small bowel obstruction after antecolic and antegastric laparoscopic Roux-en-Y gastric bypass: could the incidence be reduced? Obes Surg. 2010;20(10):1380–4.

    Article  PubMed  Google Scholar 

  6. Shimizu H, Maia M, Kroh M, Schauer PR, Brethauer SA. Surgical management of early small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2013;9(5):718–24.

    Article  PubMed  Google Scholar 

  7. Gunabushanam G, Shankar S, Czerniach DR, Kelly JJ, Perugini RA. Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass surgery. J Comput Assist Tomogr. 2009;33(3):369–75.

    Article  PubMed  Google Scholar 

  8. Husain S, Ahmed A, Johnson J. Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Arch Surg. 2007;142(10):988–93.

    Article  PubMed  Google Scholar 

  9. Lewis CE, Jensen C, Tejirian T, Dutson E, Mehran A. Early jejunojejunostomy obstruction after laparoscopic gastric bypass: case series and treatment algorithm. Surg Obes Relat Dis. 2009;5(2):203–7.

    Article  PubMed  Google Scholar 

  10. Champion JK, Williams M. Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13(4):596–600.

    Article  PubMed  Google Scholar 

  11. Rogula T, Yenumula PR, Schauer PR. A complication of Roux-en-Y gastric bypass: intestinal obstruction. Surg Endosc. 2007;21(11):1914–8.

    Article  CAS  PubMed  Google Scholar 

  12. Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003;13(3):350–4.

    Article  PubMed  Google Scholar 

  13. Cusati D, Sarr M, Kendrick M, Que F, Swain JM. Refractory strictures after Roux-en-Y gastric bypass: operative management. Surg Obes Relat Dis. 2011;7(2):165–9.

    Article  PubMed  Google Scholar 

  14. Ukleja A, Afonso BB, Pimentel R, Szomstein S, Rosenthal R. Outcome of endoscopic balloon dilation of strictures after laparoscopic gastric bypass. Surg Endosc. 2008;22(8):1746–50.

    Article  PubMed  Google Scholar 

  15. Catalano MF, Chua TY, Rudic G. Endoscopic balloon dilation of stomal stenosis following gastric bypass. Obes Surg. 2007;17(3):298–303.

    Article  PubMed  Google Scholar 

  16. Yimcharoen P, Heneghan H, Chand B, Talarico JA, Tariq N, Kroh M, et al. Successful management of gastrojejunal strictures after gastric bypass: is timing important? Surg Obes Relat Dis. 2012;8(2):151–7.

    Article  PubMed  Google Scholar 

  17. Ryskina KL, Miller KM, Aisenberg J, Herron DM, Kini SU. Routine management of stricture after gastric bypass and predictors of subsequent weight loss. Surg Endosc. 2010;24(3):554–60.

    Article  PubMed  Google Scholar 

  18. Go MR, Muscarella 2nd P, Needleman BJ, Cook CH, Melvin WS. Endoscopic management of stomal stenosis after Roux-en-Y gastric bypass. Surg Endosc. 2004;18(1):56–9.

    Article  CAS  PubMed  Google Scholar 

  19. Goitein D, Papasavas PK, Gagne D, Ahmad S, Caushaj PF. Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2005;19(5):628–32.

    Article  CAS  PubMed  Google Scholar 

  20. Markar SR, Penna M, Venkat-Ramen V, Karthikesalingam A, Hashemi M. Influence of circular stapler diameter on postoperative stenosis after laparoscopic gastrojejunal anastomosis in morbid obesity. Surg Obes Relat Dis. 2012;8(2):230–5.

    Article  PubMed  Google Scholar 

  21. Mueller CL, Jackson TD, Swanson T, Pitzul K, Daigle C, Penner T, Urbacg D, Okrainec A. Linear-stapled gastrojejunostomy with transverse hand-sewn enterotomy closure significantly reduces strictures for laparoscopic roux-en-y gastric bypass. Obes Surg. 2013;1302–08.

    Google Scholar 

  22. Brolin RE. The antiobstruction stitch in stapled Rouxen-Y enteroenterostomy. Am J Surg. 1995;169:355–7.

    Article  CAS  PubMed  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. Daellenbach L, Suter M. Jejunojejunal intussusception after Roux-en-Y gastric bypass: a review. Obes Surg. 2011;21(2):253–63. PubMed.

    Article  PubMed  Google Scholar 

  25. McAllister MS, Donoway T, Lucktong TA. Synchronous intussusceptions following Roux-en-Y Gastric Bypass: case report and review of the literature. Obes Surg. 2009;19(12):1719–23.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. Ver Steeg K. Retrograde intussusception following Roux-en-Y gastric bypass. Obes Surg. 2006;16(8):1101–3.

    Article  PubMed  Google Scholar 

  28. Varban O, Ardestani A, Azagury D, Lautz DB, Vernon AH, Robinson MK, et al. Resection or reduction? The dilemma of managing retrograde intussusception after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2013;9(5):725–30.

    Article  PubMed  Google Scholar 

  29. Awais O, Raftopoulos I, Luketich JD, Courcoulas A. Acute, complete proximal small bowel obstruction after laparoscopic gastric bypass due to intraluminal blood clot formation. Surg Obes Relat Dis. 2005;1(4):418–22.

    Article  PubMed  Google Scholar 

  30. Mala T, Sovik TT, Schou CF, Kristinsson J. Blood clot obstruction of the jejunojejunostomy after laparoscopic gastric bypass. Surg Obes Relat Dis. 2013;9(2):234–7.

    Article  PubMed  Google Scholar 

  31. Roy M, Fendrich I, Li J, Szomstein S, Rosenthal RJ. Treatment option in patient presenting with small bowel obstruction from phytobezoar at the jejunojejunal anastomosis after Roux-en-Y gastric bypass. Surg Laparosc Endosc Percutan Tech. 2012;22(4):e243–5.

    Article  PubMed  Google Scholar 

  32. Sarhan M, Shyamali B, Fakulujo A, Ahmed L. Jejunal Bezoar causing obstruction after laparoscopic Roux-en-Y gastric bypass. J Soc Laparoendosc Surg. 2010;14(4):592–5.

    Article  Google Scholar 

  33. Eid GM, Mattar SG, Hamad G, Cottam DR, Lord JL, Watson A, et al. Repair of ventral hernias in morbidly obese patients undergoing laparoscopic gastric bypass should not be deferred. Surg Endosc. 2004;18(2):207–10.

    Article  CAS  PubMed  Google Scholar 

  34. Iannelli A, Buratti MS, Novellas S, Dahman M, Amor IB, Sejor E, et al. Internal hernia as a complication of laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17(10):1283–6.

    Article  PubMed  Google Scholar 

  35. Parakh S, Soto E, Merola S. Diagnosis and management of internal hernias after laparoscopic gastric bypass. Obes Surg. 2007;17(11):1498–502.

    Article  PubMed  Google Scholar 

  36. Kawkabani Marchini A, Denys A, Paroz A, Romy S, Suter M, Desmartines N, et al. The four different types of internal hernia occurring after laparascopic Roux-en-Y gastric bypass performed for morbid obesity: are there any multidetector computed tomography (MDCT) features permitting their distinction? Obes Surg. 2011;21(4):506–16.

    Article  PubMed  Google Scholar 

  37. Han SH, White S, Patel K, Dutson E, Gracia C, Mehran A. Acute gastric remnant dilation after laparoscopic Roux-en-Y gastric bypass operation in long-standing type I diabetic patient: case report and literature review. Surg Obes Relat Dis. 2006;2(6):664–6.

    Article  PubMed  Google Scholar 

  38. López-Tomassetti Fernández EM, Arteaga González I, Diaz-Luis H, Carrillo Pallares A. Obstruction of the bypassed stomach treated with percutaneous drainage: an alternative treatment for selected cases. Obes Surg. 2008;18:233–6.

    Article  PubMed  Google Scholar 

  39. Hamoui N, Crookes PF, Kaufman HS. Percutaneous gastric drainage as a treatment for small bowel obstruction after gastric bypass. Obes Surg. 2007;17:1411–2.

    Article  PubMed  Google Scholar 

  40. Mitchell MT, Gasparaitis AE, Alverdy JC. Imaging findings in Roux-en-O and other misconstructions: rare but serious complications of Roux-en-Y gastric bypass surgery. AJR Am J Roentgenol. 2008;190(2):367–73.

    Article  PubMed  Google Scholar 

  41. Sherman V, Dan AG, Lord JM, Chand B, Schauer PR. Complications of gastric bypass: avoiding the Roux-en-O configuration. Obes Surg. 2009;19(8):1190–4.

    Article  PubMed  Google Scholar 

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Correspondence to Allan Okrainec MD, MHPE, FRCSC .

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Elnahas, A., Okrainec, A. (2016). Gastrointestinal Obstruction in the Bypass Patient. In: Herron, D. (eds) Bariatric Surgery Complications and Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-27114-9_12

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  • DOI: https://doi.org/10.1007/978-3-319-27114-9_12

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27112-5

  • Online ISBN: 978-3-319-27114-9

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