Abstract：
BACKGROUND:Despite the proliferation of laparoscopic Roux-en-Y gastric bypass (LRYGBP), postoperative bowel obstructions still occur from mesocolonic constrictions, internal hernias, and anastomotic strictures. Obstructed patients do not present with a characteristic history and physical. Therefore, radiographic studies including upper gastrointestinal films and computed tomography are essential for diagnosing these unique obstructive etiologies after LRYGBP. METHODS:From February 2000 to December 2000, 115 patients underwent standard LRYGBP at the Cleveland Clinic Foundation. Retrocolic anastomoses were performed on all patients. Defects at the mesocolon and mesomesentery were closed with interrupted, nonabsorbable sutures. All patients underwent upper gastrointestinal study on the first postoperative day. RESULTS:Six patients developed small bowel obstructions postoperatively. Five of these patients required reexploration. The obstructive etiologies were two mesocolonic constrictions, three internal herniations, and one massive clot at the gastrojejunostomy. Repair of the mesocolonic constrictions involved incising the transverse mesocolon vertically to create a larger window for the Roux limb. Internal herniations were reduced, and defects were reclosed with nonabsorbable sutures. The patient with an obstructive clot was treated endoscopically. CONCLUSIONS:Based on these 6 patients, we have altered our technique to antecolic placement of the Roux limb. This technique requires division of the omentum and additional mobilization of the Roux limb mesentery in order to decrease tension at the gastrojejunostomy. Since initiating these changes and closing all iatrogenic defects, we have not experienced further early small bowel obstructions.
journal_name
Surgeryjournal_title
Surgeryauthors
Felsher J,Brodsky J,Brody Fdoi
10.1067/s0039-6060(03)00251-4subject
Has Abstractpub_date
2003-09-01 00:00:00pages
501-5issue
3eissn
0039-6060issn
1532-7361pii
S0039606003002514journal_volume
134pub_type
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