Small Bowel Obstruction After Laparoscopic Gastric Bypass and Its Surgical Management: Experience in 10 Years.

Maria D Reyes-Salas, MD, Santiago Sherwell, MD, Roberto Rumbaut, MD, Paola Ripa-Galvan, MD. Hospital San Jose – Tecnologico De Monterrey.

 Background: An internal hernia is the most common cause of small bowel obstruction (SBO) in patients with a Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) with an incidence reported of 2 – 5%.

Objective: Present our incidence of small bowel obstruction and internal hernias after LRYGB and determine the causes.

Methods and procedures: A retrospective and descriptive study was carried out of 705 patients, reviewing charts between the years 2003 and 2012 that were operated of LRYGP and required hospitalization between those years because of an episode of small bowel obstruction. The tests and procedures used to diagnose the bowel obstruction included: physical examination, CT scan and diagnostic laparoscopy. Causes that lead to the episode of SBO were determined.

Results: 18 patients with previous LRYGP presented with SBO requiring hospitalization. 9 were female and 4 males. Ages 16-79 years (Mean 52.4, DE 17.8). The leading cause for SBO was an Internal Hernia; 13 patients (72.2%) sub-divided in transmesocolic hernia (2, 15%), Petersen’s space hernia (3, 23%) and jejunal mesentery space (8, 62%) with a mean time for presenting SBO from surgery of 26 months. 2 patients were pregnant; required surgical intervention and had no complications post-op. Others etiologies for SBO were adhesions (3 patients, 16.6%) and jejunal-jejunal anastomosis obstruction (hemobezoar and torsion). All the patients that required surgical intervention were approached laparoscopically. Conversion to open surgery was not required. The mortality rate was 0%.

Conclusion: SBO occurred with an overall incidence of 2.5% in this series of patients with a previous LRYGP. We must consider the diagnosis of an Internal hernia as the first etiology for SBO because it represents 72.2% of the causes. Our incidence of internal hernias is 1.8%, which is low compared with other series probably because of the change of the technique from retrocolic to antecolic. When indicated, the laparoscopic approach for SBO can be achieved with minimal mortality risk.

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