Skip to main content
Log in

Gastrointestinal complications of bariatric Roux-en-Y gastric bypass surgery

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Obesity is rapidly becoming the most important public health issue in USA and Europe. Roux-en-Y gastric bypass is now established as the gold standard for treating intractable morbid or super obesity. We reviewed the imaging findings following this surgery in 234 patients. In this pictorial essay we present the CT and upper gastrointestinal contrast study appearances of the expected postoperative anatomy as well as a range of abdominal complications. The complications are classified into leaks, fistula and obstruction. Postoperative gastric outlet and small bowel obstruction can be caused by anastomotic stenosis, mesocolic tunnel stenosis, adhesions, stomal ulcer, obturation, intussusception and internal or external hernia. Small bowel obstruction may be of a simple, closed loop and/or strangulating type. The radiologist should be able to diagnose the type and possible cause of obstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14

Similar content being viewed by others

References

  1. Brolin RE (2002) Bariatric surgery and long-term control of morbid obesity. J Am Med Assoc 288:2793–2796

    Article  Google Scholar 

  2. Flegal KM, Carroll MD, Ogden CL, Johnson CL (2002) Prevalence and trends in obesity among US adults, 1999–2000. J Am Med Assoc 288:1723–1727

    Article  Google Scholar 

  3. Mathus-Vliegen EM, Tygat GN (2002) Gastro-oesophageal reflux in obese subjects: influence of overweight, weight loss and chronic gastric balloon distension. Scand J Gastroenterol 37:1246–1252

    Article  CAS  PubMed  Google Scholar 

  4. Sugerman HJ (1997) Morbid obesity. In: Zinner MJ, Schwartz SI, Ellis H (eds) Maingot’s abdominal operations. Appleton & Lange, Stamford, pp 1057–1077

    Google Scholar 

  5. MacLean LD, Rhode BM, Sampalis J, Forse RA (1993) Results of the surgical treatment of obesity. Am J Surg 165:155–160

    CAS  PubMed  Google Scholar 

  6. Livingston EH (2002) Obesity and its surgical management. Am J Surg 184:103–113

    Article  PubMed  Google Scholar 

  7. Hauri P, Steffen R, Ricklin T, Riedtmann HJ, Sendi P, Horber FF (2000) Treatment of morbid obesity with the Swedish adjustable gastric band (SAGB): complication rate during a 12-month follow-up period. Surgery 127:484–488

    Article  CAS  PubMed  Google Scholar 

  8. Brolin RE, Kenler HA, Gorman JH, Cody RP (1992) Long-limb gastric bypass in the superobese. A prospective randomized study. Ann Surg 215:387–395

    CAS  PubMed  Google Scholar 

  9. Sugerman HJ, Kellum JM, Engle KM, Wolfe L, Starkey JV, Birkenhauer R, Fletcher P, Sawyer MJ (1992) Gastric bypass for treating severe obesity. Am J Clin Nutr 55:560S–566S

    CAS  PubMed  Google Scholar 

  10. Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, Barakat HA, deRamon RA, Israel G, Dolezal JM (1995) Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 222:339–350

    CAS  PubMed  Google Scholar 

  11. Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J (2000) Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232:515–529

    Article  CAS  PubMed  Google Scholar 

  12. DeMaria EJ, Sugerman HJ, Kellum JM, Meador JG, Wolfe LG (2002) Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 235:640–645

    Article  PubMed  Google Scholar 

  13. Papasavas PK, Caushaj PF, McCormick JT, Quinlin RF, Hayetian FD, Maurer J, Kelly JJ, Gagne DJ (2003) Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc 17:610–614

    Article  CAS  PubMed  Google Scholar 

  14. 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 135:1029–1033

    Article  CAS  PubMed  Google Scholar 

  15. Higa KD, Boone KB, Ho T (2000) Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients—what have we learned? Obes Surg 10:509–513

    Article  CAS  PubMed  Google Scholar 

  16. Matthews BD, Sing RF, DeLegge MH, Ponsky JL, Heniford BT (2000) Initial results with a stapled gastrojejunostomy for the laparoscopic isolated roux-en-Y gastric bypass. Am J Surg 179:476–481

    Article  CAS  PubMed  Google Scholar 

  17. Buckwalter JA, Herbst CA Jr (1988) Leaks occurring after gastric bariatric operations. Surgery 103:156–160

    CAS  PubMed  Google Scholar 

  18. Capella JF, Capella RF (1999) Gastro-gastric fistulas and marginal ulcers in gastric bypass procedures for weight reduction. Obes Surg 9:22–27

    Article  CAS  PubMed  Google Scholar 

  19. 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 223:625–632

    PubMed  Google Scholar 

  20. Sataloff DM, Lieber CP, Seinige UL (1990) Strictures following gastric stapling for morbid obesity. Results of endoscopic dilatation. Am Surg 56:167–174

    CAS  PubMed  Google Scholar 

  21. Spaulding L (1997) The impact of small bowel resection on the incidence of stomal stenosis and marginal ulcer after gastric bypass. Obes Surg 7:485–487

    Article  CAS  PubMed  Google Scholar 

  22. Capella JF, Capella RF (2002) An assessment of vertical banded gastroplasty-Roux-en-Y gastric bypass for the treatment of morbid obesity. Am J Surg 183:117–123

    Article  PubMed  Google Scholar 

  23. Balthazar EJ, Bauman JS, Megibow AJ (1985) CT diagnosis of closed loop obstruction. J Comput Assist Tomogr 9:953–955

    CAS  PubMed  Google Scholar 

  24. Balthazar EJ, Birnbaum BA, Megibow AJ, Gordon RB, Whelan CA, Hulnick DH (1992) Closed-loop and strangulating intestinal obstruction: CT signs. Radiology 185:769–775

    CAS  PubMed  Google Scholar 

  25. Horton KM, Fishman EK (2003) The current status of multidetector row CT and three-dimensional imaging of the small bowel. Radiol Clin North Am 41:199–212

    PubMed  Google Scholar 

  26. Felsher J, Brodsky J, Brody F (2003) Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Surgery 134:501–505

    Article  PubMed  Google Scholar 

  27. Blachar A, Federle MP (2002) Gastrointestinal complications of laparoscopic roux-en-Y gastric bypass surgery in patients who are morbidly obese: findings on radiography and CT. Am J Roentgenol 179:1437–1442

    Google Scholar 

  28. Matthews BD, Heniford BT, Sing RF (2001) Preperitoneal Richter hernia after a laparoscopic gastric bypass. Surg Laparosc Endosc Percutan Tech 11:47–49

    Article  CAS  PubMed  Google Scholar 

  29. Williams MD, Flowers SS, Fenoglio ME, Brown TR (1995) Richter hernia: a rare complication of laparoscopy. Surg Laparosc Endosc 5:419–421

    CAS  PubMed  Google Scholar 

  30. Steinke W, Zellweger R (2000) Richter’s hernia and Sir Frederick Treves: an original clinical experience, review, and historical overview. Ann Surg 232:710–718

    Article  CAS  PubMed  Google Scholar 

  31. Duane TM, Wohlgemuth S, Ruffin K (2000) Intussusception after Roux-en-Y gastric bypass. Am Surg 66:82–84

    CAS  PubMed  Google Scholar 

  32. Ko S, Lee T, Ng S (1997) Small bowel obstruction due to phytobezoar: CT diagnosis. Abdom Imaging 22:471–473

    Article  CAS  PubMed  Google Scholar 

  33. Sandrasegaran K, Maglinte DD, Howard TJ, Kelvin FM, Lappas JC (2003) The multifaceted role of radiology in small bowel obstruction. Semin Ultrasound CT MR 24:319–335

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kumaresan Sandrasegaran.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sandrasegaran, K., Rajesh, A., Lall, C. et al. Gastrointestinal complications of bariatric Roux-en-Y gastric bypass surgery. Eur Radiol 15, 254–262 (2005). https://doi.org/10.1007/s00330-004-2520-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-004-2520-0

Keywords

Navigation