Peter Vasas1, Abdulzahra Hussain2, Corinne Owers2, Sashi Yeluri2, Srinivasan Balchandra2. 1. Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, South Yorkshire, UK. vasasdr@gmail.com. 2. Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, South Yorkshire, UK.
Abstract
INTRODUCTION: Roux-en-Y gastric bypass (RYGB) remains one of the key bariatric procedures worldwide. In addition to bleeding and anastomotic leak, there are rarely occurring complications such as obstruction at the jejuno-jejunostomy in the early postoperative phase. PATIENT AND METHODS: A 51-year-old lady (weight 122 kg; BMI 46 kg/m2; with type 2 diabetes mellitus and hypertension) underwent RYGB in our tertiary referral centre 3 days prior to admission. She originally recovered well from the uneventful operation, but began vomiting on day 3. At this point, she complained of no other symptoms. An urgent CT scan identified a gastric remnant dilatation, and an obstructed jejuno-jejunostomy. An urgent laparoscopic exploration was performed, which identified obstruction at this level. RESULTS: Within our video-presentation, detailed technical steps are described. First, gastric remnant decompression was performed by inserting a tube gastrostomy. Secondly, the obstruction was identified. Consequently, a new jejuno-jejunostomy was created, proximal to the original anastomosis, using a linear stapler, and direct suture closure of the enterotomy defects. After thorough washout, drains were placed in the pelvis and alongside the jejuno-jejunostomy. The patient was discharged home after a 2-week hospital stay which included 5 days of invasive ventilation on the ITU. CONCLUSION: A high-level of suspicion is required to suspect, diagnose and treat post-RYGB complications. A bariatric on-call rota with appropriately trained personnel is essential.
INTRODUCTION: Roux-en-Y gastric bypass (RYGB) remains one of the key bariatric procedures worldwide. In addition to bleeding and anastomotic leak, there are rarely occurring complications such as obstruction at the jejuno-jejunostomy in the early postoperative phase. PATIENT AND METHODS: A 51-year-old lady (weight 122 kg; BMI 46 kg/m2; with type 2 diabetes mellitus and hypertension) underwent RYGB in our tertiary referral centre 3 days prior to admission. She originally recovered well from the uneventful operation, but began vomiting on day 3. At this point, she complained of no other symptoms. An urgent CT scan identified a gastric remnant dilatation, and an obstructed jejuno-jejunostomy. An urgent laparoscopic exploration was performed, which identified obstruction at this level. RESULTS: Within our video-presentation, detailed technical steps are described. First, gastric remnant decompression was performed by inserting a tube gastrostomy. Secondly, the obstruction was identified. Consequently, a new jejuno-jejunostomy was created, proximal to the original anastomosis, using a linear stapler, and direct suture closure of the enterotomy defects. After thorough washout, drains were placed in the pelvis and alongside the jejuno-jejunostomy. The patient was discharged home after a 2-week hospital stay which included 5 days of invasive ventilation on the ITU. CONCLUSION: A high-level of suspicion is required to suspect, diagnose and treat post-RYGB complications. A bariatric on-call rota with appropriately trained personnel is essential.
Authors: Jad Khoraki; Guilherme S Mazzini; Amar S Shah; Paul A R Del Prado; Luke G Wolfe; Guilherme M Campos Journal: Surg Obes Relat Dis Date: 2018-05-23 Impact factor: 4.734
Authors: Peter Vasas; Waleed Al-Khyatt; Iskandar Idris; Paul C Leeder; Altaf K Awan; Sherif Awad; Javed Ahmed Journal: World J Surg Date: 2016-11 Impact factor: 3.352