Laparoscopic revision of jejuno-jejunostomy for recurrent intussusception after Roux-en-Y gastric bypass.

Yulia Zak, MD, Denise W Gee, MD. Massachusetts General Hospital

OBJECTIVES: Intussusception is a rare complication after laparoscopic Roux-en-Y gastric bypass that can manifest in recurrent small bowel obstruction. We present a 42-year-old female patient with prior laparoscopic retrocolic retrogastric Roux-en-Y gastric bypass who, after multiple hospital admissions with abdominal pain and obstructive symptoms, was demonstrated on CT to have intussusception at the jejuno-jejunostomy.

METHODS: Initial diagnostic laparoscopy confirmed the finding, with the Roux limb prolapsing into the common channel. An enteropexy was performed, but unfortunately, did not resolve the patient’s symptoms. Therefore, laparoscopic revision of the jejuno-jejunostomy was undertaken. This was performed by first completely excising the anastomosis with transection of the Roux, biliopancreatic, and common limbs using EndoGIA 2.5mm loads. Then, a side-to-side functional end-to-end stapled anastomosis was created between the Roux limb and the common channel using the triple stapling technique. Finally, the biliopancreatic limb was anastomosed to the common limb 10 cm distal to the first anastomosis. The two new mesenteric defects were closed with a running suture. The anatomy was verified before closure.

RESULTS: The patient recovered well, was discharged home on POD 2, and has experienced resolution of her abdominal symptoms.

CONCLUSIONS: Laparoscopic revision of jejuno-jejunostomy with complete excision of the affected anastomosis is an effective treatment for the rare complication of intussusception after Roux-en-Y gastric bypass.

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