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Etiology, Diagnosis, and Management

Syed Husain, MD; Ahmed R. Ahmed, MD, FRCS; Joseph Johnson, MD; Thad Boss, MD; William O’Malley, MD

Arch Surg. 2007;142(10):988-993.

Objective  To summarize our experience with small-bowel obstructions after laparoscopic Roux-en-Y gastric bypass.

Design  Retrospective record review.

Setting  University-affiliated hospital.

Patients  One hundred five consecutive patients undergoing surgery for intestinal obstruction after laparoscopic Roux-en-Y gastric bypass between May 24, 2001, and December 1, 2006.

Main Outcome Measures  Common presenting symptoms, causes, yield of radiological studies, and types of surgical procedures performed for post–gastric bypass bowel obstruction.

Results  A total of 2325 laparoscopic Roux-en-Y gastric bypass procedures were performed during the study period. A total of 105 patients underwent 111 procedures. Bowel obstruction was confirmed in 102 patients, yielding an overall incidence of 4.4%. The most common presenting symptom was abdominal pain (82.0%), followed by nausea (48.6%) and vomiting (46.8%). Thirty-one patients (27.9%) presented with all of the 3 mentioned symptoms. The mean time to presentation was 313 days after bypass (range, 3-1215 days). Among the studies, results in 48.0% of computed tomographic scans, 55.4% of upper gastrointestinal studies, and 34.8% of plain abdominal radiography studies were positive for intestinal obstruction. In 15 patients (13.5%), all of the radiological study results were negative. The most common causes were internal hernias (53.9%), Roux compression due to mesocolon scarring (20.5%), and adhesions (13.7%). Laparoscopic explorations were carried out in 92 cases (82.9%). The incidences of bowel obstructions were 4.8% with retrocolic Roux placement and 1.8% with antecolic Roux placement.

Conclusions  Altered gastrointestinal tract anatomy results in vague symptoms and a poor yield with imaging studies. A sound knowledge of altered anatomy is the key to correct interpretation of imaging studies and prompt diagnosis.

Author Affiliations: Division of Gastrointestinal and Bariatric Surgery, Department of Surgery, University of Rochester, Rochester, New York. Dr Husain is now with the Department of Surgery, Brown University, Providence, Rhode Island.

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