Ramsey M Dallal1, Linda A Bailey. 1. Albert Einstein Healthcare Network, Philadelphia, PA. USA. dallalr@einstein.edu
Abstract
BACKGROUND: The antecolic approach to the laparoscopic Roux-en-Y gastric bypass (LGB) has been demonstrated to decrease the incidence of internal herniation. However, specific complications of this approach have not been documented. We describe the clinical presentation related to complications of this technique. METHODS: The outcomes of 201 consecutive patients who had undergone antecolic LGB by a single surgeon during a 24-month period were retrospectively evaluated for complications. RESULTS: Of the 201 LGB patients, 3 (1.5%) developed complications attributable to omental division. All 3 had an identical presentation of acute, localized abdominal pain without significant signs of systemic illness. All 3 patients developed acute symptoms on postoperative day 3. Laparoscopic reexploration on postoperative day 3, 4, and 4 demonstrated partial omental infarction without other pathologic findings. All patients had immediate relief of symptoms and had no further complications. CONCLUSION: Partial omental infarction is a complication of omental transection while performing the antecolic approach to the LGB. Omental infarction should be part of the differential diagnosis, including anastomotic leak, in patients who develop abdominal pain 3-4 days after LGB.
BACKGROUND: The antecolic approach to the laparoscopic Roux-en-Y gastric bypass (LGB) has been demonstrated to decrease the incidence of internal herniation. However, specific complications of this approach have not been documented. We describe the clinical presentation related to complications of this technique. METHODS: The outcomes of 201 consecutive patients who had undergone antecolic LGB by a single surgeon during a 24-month period were retrospectively evaluated for complications. RESULTS: Of the 201 LGB patients, 3 (1.5%) developed complications attributable to omental division. All 3 had an identical presentation of acute, localized abdominal pain without significant signs of systemic illness. All 3patients developed acute symptoms on postoperative day 3. Laparoscopic reexploration on postoperative day 3, 4, and 4 demonstrated partial omental infarction without other pathologic findings. All patients had immediate relief of symptoms and had no further complications. CONCLUSION: Partial omental infarction is a complication of omental transection while performing the antecolic approach to the LGB. Omental infarction should be part of the differential diagnosis, including anastomotic leak, in patients who develop abdominal pain 3-4 days after LGB.
Authors: Ammar A Javed; Fabio Bagante; Ralph H Hruban; Matthew J Weiss; Martin A Makary; Kenzo Hirose; John L Cameron; Christopher L Wolfgang; Elliot K Fishman Journal: J Gastrointest Surg Date: 2015-08-25 Impact factor: 3.452