Mauricio Gabrielli1, Cristian Jarry2, Sebastián Hurtado3, Pablo Achurra4, Rodrigo Muñoz4, Nicolas Quezada4, Fernando Crovari4. 1. Digestive Surgery Department, Surgery Division, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile. mgabrie@med.puc.cl. 2. Surgery Division, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile. 3. Faculty of Medicine, Pontificia Universidad Católica de Chile, Avda. Libertador Bernando O'Higgins 340, Santiago, Chile. 4. Digestive Surgery Department, Surgery Division, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile.
Abstract
PURPOSE: This study aims to describe the incidence, associated factors, etiology, and management of small bowel obstructions following laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: A retrospective analysis was conducted between January 15 and December 19 using the surgery database of our hospital. Included LRYGB patients were those that evolved with a prolonged length of stay; readmission; emergency room consult; and re-intervention due to small bowel obstruction (SBO) related symptoms with compatible radiological or intraoperative findings. The LRYGB technique implied an antecolic alimentary limb reconstruction and systematic closure of mesenteric defects. Descriptive and analytical statistics were carried out, using a parametric or non-parametric approach as needed. RESULTS: Nine hundred forty-one LRYGB were performed. 9.9% were revisional surgeries of patients with a laparoscopic sleeve gastrectomy. During the study period, 36 SBOs occurred, representing 3.8% of operated patients, with no mortality. 58.3% had successful non-operative management, while 41.7% required surgical exploration, of which 73.3% were treated laparoscopically and 20% needed conversion to open surgery. Etiologies of SBO were jejuno-jejunostomy (JJO) related stenosis (22, 61.1%), internal hernias (6, 16.7%), adherences (3, 8.3%), and other diagnoses (5, 13.9%). Regarding JJO stenosis and internal hernias, median time to diagnosis was 8 days (IQR 7-11) and 12 months (IQR 8.7-16) respectively. Previous sleeve gastrectomy, age, or sex was not associated to the incidence of small bowel obstruction. CONCLUSIONS: LRYGB is safe when performed by experienced surgeons. SBO due to internal hernias were scarce in this series. JJO stenosis could explain most cases of SBO; under this diagnosis, non-surgical management was successful frequently.
PURPOSE: This study aims to describe the incidence, associated factors, etiology, and management of small bowel obstructions following laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: A retrospective analysis was conducted between January 15 and December 19 using the surgery database of our hospital. Included LRYGB patients were those that evolved with a prolonged length of stay; readmission; emergency room consult; and re-intervention due to small bowel obstruction (SBO) related symptoms with compatible radiological or intraoperative findings. The LRYGB technique implied an antecolic alimentary limb reconstruction and systematic closure of mesenteric defects. Descriptive and analytical statistics were carried out, using a parametric or non-parametric approach as needed. RESULTS: Nine hundred forty-one LRYGB were performed. 9.9% were revisional surgeries of patients with a laparoscopic sleeve gastrectomy. During the study period, 36 SBOs occurred, representing 3.8% of operated patients, with no mortality. 58.3% had successful non-operative management, while 41.7% required surgical exploration, of which 73.3% were treated laparoscopically and 20% needed conversion to open surgery. Etiologies of SBO were jejuno-jejunostomy (JJO) related stenosis (22, 61.1%), internal hernias (6, 16.7%), adherences (3, 8.3%), and other diagnoses (5, 13.9%). Regarding JJO stenosis and internal hernias, median time to diagnosis was 8 days (IQR 7-11) and 12 months (IQR 8.7-16) respectively. Previous sleeve gastrectomy, age, or sex was not associated to the incidence of small bowel obstruction. CONCLUSIONS: LRYGB is safe when performed by experienced surgeons. SBO due to internal hernias were scarce in this series. JJO stenosis could explain most cases of SBO; under this diagnosis, non-surgical management was successful frequently.
Authors: Ted D Adams; Lance E Davidson; Sheldon E Litwin; Jaewhan Kim; Ronette L Kolotkin; M Nazeem Nanjee; Jonathan M Gutierrez; Sara J Frogley; Anna R Ibele; Eliot A Brinton; Paul N Hopkins; Rodrick McKinlay; Steven C Simper; Steven C Hunt Journal: N Engl J Med Date: 2017-09-21 Impact factor: 91.245
Authors: Ralph Peterli; Bettina Karin Wölnerhanssen; Thomas Peters; Diana Vetter; Dino Kröll; Yves Borbély; Bernd Schultes; Christoph Beglinger; Jürgen Drewe; Marc Schiesser; Philipp Nett; Marco Bueter Journal: JAMA Date: 2018-01-16 Impact factor: 56.272
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