Causes of Small Bowel Obstruction After Gastric Bypass: A Review of 1000 Cases at a Single Institution

Luke Elms, MD, Rena Moon, MD, Andre Teixeira, MD, Muhammad Jawad, MD, FACS

Department of Bariatric Surgery, Orlando Regional Medical Center

Introduction: Internal hernia is a relatively common post operative complication after Roux-en-Y gastric bypass(RYGB) procedure. It has been reported that 5-7% of RYGB patients develop internal herniation through Peterson’s or mesenteric defect. However, considerable number of patients presenting with possible small bowel obstruction(SBO) after RYGB do not always have internal herniation. The aim of our study is to determine the causes of small bowel obstruction with both potential internal hernia spaces closed at the time of original operation.

Material and Methods: From April 2008 to April 2011, a total of 1000 patients underwent laparoscopic antecolic, antegastric RYGB at a single institution. All of these patients had both Peterson’s and jejunojejunostomy mesenteric defect closed at the time of RYGB with a 2.0 polysorb. A retrospective review of a prospectively collected data was performed for all RYGB patients, noting the outcomes and complications of the procedure.

Results: Eighty-two patients out of the 1000 reviewed had 98 reoperations in the study period resulting in a reoperation rate of 8.2%. In this group of patients, 26 (26.5%) presented with abdominal pain and possible SBO, resulting in 28 re-operations. Of these 26 patients, 13 (50.0%) were found to have internal herniation, and 11 (42.3%) were found to have adhesions. Two (7.7%) patients had other causes for the abdominal pain. Overall, reoperation rate due to internal herniation was 1.3% in our patient population at a mean follow-up of 14 months.

Conclusion: Our findings indicated 2.6% reoperation rate for abdominal pain and possible SBO, and more than 40% of these patients had symptoms secondary to adhesions. Only 1.3% of our RYGB patients developed internal herniation after closure of both internal hernia spaces.

Session: Poster Presentation

Program Number: P408

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